Abstract
Purpose :
Inflammatory pathway plays key role in pathogenesis of macular edema in Retinal Venous Occlusions(RVO).With no well-defined criteria regarding the choice of intravitreal drug therapy,this study tests the hypothesis of tailor made approach to intravitreal therapy,which constitutes determining the levels of primary inflammatory mediators which are vascular endothelial growth factor(VEGF),interleukin 6(IL 6) and interleukin 8(IL 8) in aqueous humour and modulation of therapy in the form of anti VEGF agents or steroids depending upon the predominant inflammatory mediator involved.
Methods :
A prospective interventional case study comprising 7 eyes with macular edema in recalcitrant cases of RVO who underwent > 3 AntiVEGF injections.Comprehensive eye examination included Corrected Distance visual acuity (CDVA),fundus fluorescein angiography and Spectral Domain Optical Coherence omography(SDOCT). Aqueous samples were obtained before and 4 weeks after the intravitreal injection and 3 primary cytokines(VEGF,IL6,IL8) were measured via multiplex bead assay. Normative data of the cytokines were determined from patients undergoing cataract surgery.Customization of therapy involved classifying patients into three groups,VEGF group with high VEGF levels and were given anti VEGF therapy.Interleukin group with high interleukin levels and were given steroid injection and Mixed group where either all three cytokines were low or high and given Anti VEGF or combination therapy respectively. Statistical analysis done using SPSS V.17.0 for Windows.Outcome measures were Central Foveal Thickness, CDVA and biomarker levels .
Results :
Both cases and controls were matched for demographic characterstics.Quantitative analysis yielded higher mean VEGF,IL6,IL8 levels in RVO cases as compared to controls with increment in IL8 levels being significant(p<0.009).Delivery of customized therapy translated in significant reduction of CFT(P<0.018),improvement in CDVA(p<0.038),complete resolution of macular edema in all cases and reduction in biomarker levels throughout the spectrum of cases
Conclusions :
Aqueous levels of inflammatory cytokines and growth factors (IL6, IL8, VEGF) were significantly elevated in eyes with macular edema secondary to RVO and bespoke therapeutical approach led to significant functional and anatomical improvement in refractory cases.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.