Abstract
AimsTo study the association between peripheral blood metabolic and inflammatory factors and presence of diabetic macular edema (DME) and its related anatomic features in type 2 diabetic mellitus (T2DM) patients.Material and methodsObservational cross-sectional study on a proof of concept basis. Seventy-six T2DM included patients were divided based on the presence (n = 58) or absence of DME (n = 18) according to optical coherence tomography (OCT). Ultra-widefield fluorescein angiography (UWFA) was performed in DME patients. Fasting peripheral blood sample testing included glycemia, glycated hemoglobin, creatinin and lipid levels among others. Serum levels of a broad panel of cytokines and inflammatory mediators were also analysed. OCT findings included central subfoveal thickness, diffuse retinal thickness (DRT), cystoid macular edema (CME), serous retinal detachment and epirretinal membrane. UWFA items included pattern of DME, presence of peripheral retinal ischemia and enlarged foveal avascular zone (FAZ).ResultsMetabolic and inflammatory factors did not statistically differ between groups. However, several inflammatory mediators did associate to certain ocular items of DME cases: IL-6 was significantly higher in patients with DRT (p = 0.044), IL-10 was decreased in patients with CME (p = 0.012), and higher IL-8 (p = 0.031) and VEGF levels (p = 0.031) were observed in patients with enlarged FAZ.ConclusionInflammatory and metabolic peripheral blood factors in T2DM may not be differentially associated to DME when compared to non-DME cases. However, some OCT and UWFA features of DME such as DRT, CME and enlarged FAZ may be associated to certain systemic inflammatory mediators.
Highlights
Several inflammatory mediators did associate to certain ocular items of diabetic macular edema (DME) cases: IL-6 was significantly higher in patients with diffuse retinal thickness (DRT) (p = 0.044), IL-10 was decreased in patients with cystoid macular edema (CME) (p = 0.012), and higher IL-8 (p = 0.031) and vascular endothelial growth factor (VEGF) levels (p = 0.031) were observed in patients with enlarged foveal avascular zone (FAZ)
Inflammatory and metabolic peripheral blood factors in Type 2 Diabetes Mellitus (DM) (T2DM) may not be differentially associated to DME when compared to non-DME cases
Some optical coherence tomography (OCT) and Ultra-widefield fluorescein angiography (UWFA) features of DME such as DRT, CME and enlarged FAZ may be associated to certain systemic inflammatory mediators
Summary
Diabetic retinopathy (DR) is the most common microvascular complication of Diabetes Mellitus (DM) and is characterized by progressive retinal microvascular changes leading to tissue ischemia, increased permeability, neovascularization and edema.[1]. The pathogenesis of DME in T2DM is thought to be associated with increased vascular permeability due to breakdown of the blood–retinal barrier (BRB) and the blood–aqueous barrier. This breakdown is driven by the inflammation and oxidative stress produced by high levels of advanced glycation end-products.[7] Such events present with characteristic cellular and functional changes due to inflammation taking place in DR: leukostasis, abnormal leuckocyte adherence and increased permeability of retinal vascular barriers.[8] This global systemic inflammatory environment has been widely studied in diabetic patients. This global systemic inflammatory environment has been widely studied in diabetic patients. [8,9,10,11,12] it remains unclear whether the pathophysiology of DME is mainly attributed to such systemic affection or to a local (intraocular) response
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