Correlation between intravitreal glucose concentration, the cytologic profile and anatomical changes in patients undergoing vitreoretinal surgery.

Abstract

Purpose: Assess the potential correlation between intravitreal glucose concentration, the cytologic profile and anatomical changes in patients undergoing vitreoretinal surgery.

Methods: In a single-center prospective study from February 2014 to November 2014, intravitreal glucose concentration was analyzed in patients undergoing vitrectomy for retinal detachment or epiretinal membrane. Cytological exploration was carried out with optical microscopy after cytospin vitreous fluid collection during surgery and Papanicolaou staining. An immunohistochemistry test was performed using AE1/AE3, CD68, vimentin and GFAP antibodies. The vitreous cytology was described and evaluated with a semi quantitative method.

Results: 53 patients were included in our study. A statistically significant difference (p <0.0001) of the average intravitreal glucose concentration between retinal detachment groups (2.37 mmol / l +/- 0.72) and epiretinal membrane (1.6 mmol / l +/- 1.1) was found. The overall cellularity was increased during retinal detachments to idiopathic epiretinal membranes (p = 0.009). The analysis of different cell types in these two populations showed a significant difference in the density of macrophages and neutrophils (p = 0.00002 and 0.04). In patients with retinal detachment, the amount of epithelial cells in the vitreous was significantly higher in the group with surgical failure due to vitreoretinal proliferation compared with the group with successful surgery (p = 0.04).<br /> There was a direct link between glucose concentration and the amount of macrophages (p <0.0243) Anova test. Using the Kruskal Wallis test with pairwise Bonferroni correction, the glucose concentration remained significant lower in the group with no macrophages compared with the group with a high amount of macrophages (p=0.0095).

Conclusions: Increased intravitreal glucose concentration could lead to the accumulation of advanced glycation end products activating macrophages via AGE receptors in patients with a retinal detachment.<br /> Glycation is responsible for cross linking of the vitreous collagen in both diabetic and non-diabetic patients. This cross linking could be responsible for loss of collagen elasticity leading to rhegmatogenous lesions responsible for retinal detachment.