Abstract
Purpose :
With Spectral domain optical coherence tomography(SDOCT) emerging as a primary guiding tool in managing diabetic macular edema, this retrospective cross sectional case-control study investigated the relationship between aqueous humour biomarkers(Interleukins{IL6,IL8,il1α},Monocyte chemoattractant protein1{MCP1},Interferon1 alpha{INF1α},Vascular endothelial growth factor{VEGF},Intercellular Adhesion Molecule1{ICAM1/CD54},vascular cell adhesion molecule1{VCAM1},Angiogenin,fractalkine) and morphological patterns of diabetic macular edema on OCT in eyes with varied response to intravitreal therapy
Methods :
54 eyes of patients with diabetic macular edema(16 cases of responders,9 treatment naïve and 29 non responders)and 18 eyes of age matched controls undergoing cataract surgery participated in the study.OCT scans were evaluated for the presence of different morphological patterns of macular edema,layer of retina with predominant fluid accumulation,central foveal thickness and choroidal thickness.Aqueous levels of the biomarkers were measured via multiplex bead assay and analysed using SPSS V.17.0 for Windows. Primary outcome measure was mean cytokine concentration levels which were correlated with tomographic patterns of macular edema and response to intravitreal therapy.
Results :
Cases and controls were matched for demographic characteristics, CFT and CT.All 11 cytokine levels were significantly elevated in cases as compared to controls. Non responders had significantly elevated levels of IL 8, ICAM 1 and VCAM (p<0.05) while IL1 was elevated in responders.Diffuse edema and subretinal fluid were seen predominantly in nonresponders( 8/12 and 8/13 eyes respectively,p<0.05). Diffuse tomographic pattern of edema had significantly elevated levels of MCP1, ICAM1, VCAM1 and fractalkine (p<0.05) while cystoid pattern was associated with elevated levels of MCP1, IL 8, ICAM1, VCAM1 and fractalkine, eyes with subretinal fluid accumulation demonstrated elevated MCP 1, IL8 and ICAM1 levels as compared to controls
Conclusions :
Non response to anti VEGF therapy is associated with diffuse retinal thickening and presence of SRF due to elevated ICAM1 and VCAM1 in diffuse pattern and elevated levels of IL8 and ICAM1 in cystic pattern of edema with SRF.This creates a whole new dimension and opens gateway to customization of therapy in future with non invasive tomographic imaging serving as the primary guiding tool.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.