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Mauro Cellini, Ernesto Strobbe, Nicole Balducci, Alberto Pazzaglia, Emilio C. Campos; Subtenon injection of natural leucocytic interferon-α 2a for treatment of diabetic macular edema. Preliminary results. Invest. Ophthalmol. Vis. Sci. 2012;53(14):406.
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To report the effect of subtenon natural leucocytic interferon-α 2a (IFN-α) on best corrected visual acuity (BCVA) and macular thickness (MT) in diabetic macular edema (DME) refractory to intravitreal injection of bevacizumab and laser grid therapy
20 patients affected by DME received a complete ophthalmic examination including BCVA, indirect ophthalmoscopy and spectral domain ocular coherence tomography (SD-OCT) of the macular region (HRA2, Heidelberg Engineering, Heidelberg, Germany) preoperatively and 1 week, 1 month and 4 months after the third injection of a cycle of 3 subtenon injections/week of IFN-α (1x106 IU/ml)
Both BCVA and MT significantly improved after 4 months following the last injection (P<0.001, Friedman test). Specifically, SD-OCT images showed a significant reduction in MT after 1 week (501.54µm±25.81 vs 258.61µm±20.39). Later, MT increased after 1 and 4 months, but it was still significantly lower as compared to the baseline value (279.83µm±25.27 and 288.71µm±33.49, respectively). Similarly, BCVA expressed in LogMAR significantly improved after the first week (0.4±0.04 vs 0.31±0.07), was stable after 1 month (0.31±0.08) and it slightly decreased after 4 months (0.32±0.09) but it was still better as compared to the baseline value. No side effects were recorded.
IFN-α, with its immunomodulatory, antiproliferative and antiangiogenic actions, is effective in improving visual acuity and reducing macular thickness in DME, even if its effect slightly decreases after 4 months from the last injection. In fact, IFN-α enhances the barrier function of retinal microvascular endothelium and inhibits VEGF and other cytokines like IL-8, IL-10 and TGF-β. Subtenon injection is able to reach intravitreal concentrations higher than systemic injection and is well tolerated. Further randomized controlled studies would be useful to assess the effect of IFN-α alone or in combination with other therapies for DME treatment
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