The usefulness of systemic inflammatory markers as diagnostic indicators of the
            pathogenesis of diabetic macular edema

İlhan, Çağrı; Çıtırık, Mehmet; Uzel, Mehmet Murat; Kızıltoprak, Hasan; Tekin, Kemal

doi:10.5935/0004-2749.20200051

Cited by 13 publications

(7 citation statements)

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“…Woo et al [25] showed that the circulating neutrophil counts in DR patients were higher and related to the severity of DR, indicating that peripheral blood neutrophil-mediated inflammation played an important role in the pathogenesis of DR, no emphasis was placed on the presence of DME. There is no study has hitherto reported the relationship between inflammatory markers and different stages of DME [10, 26]. Our results revealed that the changes in systemic inflammatory indices including CRP, NLR, PLR, MLR, and SII, show a consistent trend among different stages of DME.…”

Section: Discussionsupporting

confidence: 65%

Optical Coherence Tomography-Based Grading of Diabetic Macular Edema Is Associated with Systemic Inflammatory Indices and Imaging Biomarkers

Yanxia,

Xiongyi,

Min

et al. 2024

Ophthalmic Res

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Introduction: Objectives of the study were to investigate the correlation between OCT-based grading of diabetic macular edema (DME) and systemic inflammatory indices, imaging biomarkers, and early anti-VEGF treatment response. Methods: A total of 111 eyes from 111 patients with DME treated with intravitreous anti-VEGF therapy for 3 consecutive months every month were enrolled in this retrospective study. According to a protocol termed "TCED", DME was divided into early, progressive, severe and atrophic stages. The best-corrected visual acuity (BCVA), subretinal fluid (SRF) and the number of hyperreflective foci (HRF) in the whole retinal layers were analyzed at baseline and three months after the first injection. Peripheral blood inflammatory indices were calculated, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet (PLT)-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and C-reactive protein (CRP). Statistical analysis were performed to compare the visual and anatomical results and evaluate HRF and SRF in different stages of DME before and after treatment. Results: There were significant differences in systemic inflammatory indices among the four groups, including NLR, PLR, MLR, SII and CRP ( all P < 0.05). The CRP, NLR, PLR, MLR, and SII were significantly higher in the atrophic stage compared to the advanced stage (all P < 0.05). Conversely, the CRP, NLR, PLR, MLR, and SII were significantly lower in the advanced stage compared to the early stage (all P < 0.05). Except for the atrophic stage, BCVA and CRT were significantly improved after treatment in early, advanced and severe stages (all P < 0.05), especially in the severe stage. The decline in the proportion of SRF and HRF ≥ 20 were the most significant in the advanced stage after anti-VEGF treatment (P < 0.001, P = 0.016), but not in the early and severe stages (all P > 0.05). Conclusion: Systemic inflammatory indices and the decline in the proportion of SRF and HRF ≥ 20 were closely associated with different stages of DME based on "TCED". Meanwhile, the "TCED" grading system can predict visual and anatomical prognosis of DME after anti-VEGF treatment, which may be a biomarker for identifying risk stratification and management of DME.

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Section: Discussionsupporting

confidence: 65%

Optical Coherence Tomography-Based Grading of Diabetic Macular Edema Is Associated with Systemic Inflammatory Indices and Imaging Biomarkers

Yanxia,

Xiongyi,

Min

et al. 2024

Ophthalmic Res

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“…Ilhan et al (20) found the NLR was higher in their DME group than in two other control groups and concluded that NLR was a highly sensitive and specific diagnostic indicator of DME. Hu et al (10) followed up 91 DME patients treated with intravitreal injection of anti-VEGF drugs and found that a higher NLR before treatment was associated with worse BCVA prognosis.…”

Section: Discussionmentioning

confidence: 90%

Peripheral white blood cell subtypes and the development/progression of diabetic macular edema in type 2 diabetic patients: a comparative study

Zhu¹,

Xu²,

Li³

et al. 2022

Ann Palliat Med

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Background: Inflammation and immune dysregulation are involved in the pathogenesis of diabetic macular edema (DME). The progressive increase of neutrophils in peripheral blood can lead to the increase of the number of neutrophils in the retina, thus leading to the sustained damage of the retinal vascular system and the destruction of the blood retinal barrier (BRB); lymphocytes play a protective role in vascular diseases caused by type 2 diabetes mellitus (T2DM). The purpose of this study was to study the relationship between the changes of leukocytes and their classification in peripheral blood and the occurrence and progression of DME in patients with T2DM. Methods: A retrospective analysis was made on 81 patients with T2DM with DME (DME group) hospitalized in our hospital from January 2019 to December 2020. According to the morphological characteristics of macular edema in optical coherence tomography (OCT), they were divided into early DME group (n=33) and late DME group (n=48); 33 patients with diabetes retinopathy (DR) but without DME matched in age and course of disease served as the control group (NO-DME group). The clinical parameters assessed included eye examination, OCT results, WBCs and subtypes, blood glucose, and glycosylated hemoglobin.Results: Compared with NO-DME group (n=33), Neutrophils% in DME group (n=81) was higher (57.37±9.52 vs. 63.27±7.85; P=0.001); Monocyte% (7.63±1.77 vs. 6.88±1.83; P=0.047) and lymphocyte% (30.35±9.51 vs. 27.26±6.59; P=0.032) were decreased. The optimal model was obtained with R 4.0.5 software.With other relevant variables being the same, females had a significantly increased risk of DME (b=1.273, P=0.015), %neutrophils was significantly associated with increased risk of DME (b=0.152, P=0.0006), and %lymphocytes was significantly associated with a reduced risk of DME (b=−0.027, P=0.179). However, in the early and late DME groups, no significant differences in biological markers were found, and a high-quality model was not obtained.Conclusions: In this preliminary study, %neutrophils is associated with increased risk of DME, whereas %lymphocytes is associated with a reduced risk of DME.

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“…NLR has become a reliable predictor of DR (10,38), while WBCs have been reported to directly cause retinal endothelial cell death and blood-retina barrier dysfunction (39,40). In Ilhan et al's study (41), NLR was found to be higher in a DME group than in two other control groups, and it was concluded that NLR is a highly sensitive and specific diagnostic indicator of DME.…”

Section: Discussionmentioning

confidence: 97%

The relationship between peripheral blood inflammatory markers and diabetic macular edema in patients with severe diabetic retinopathy

Zhu¹,

Cai²,

Li³

et al. 2022

Ann Palliat Med

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Background: Diabetic macular edema (DME) is a serious complication of diabetic retinopathy (DR).Recent studies have shown that inflammation is closely associated with the development of DME, and peripheral blood inflammatory markers [white blood cell (WBC) count and its subtypes] are relatively simple and easy to detect. Here, we investigated the relationship between peripheral blood inflammatory markers and macular edema in patients with severe DR (including both severe non-proliferative DR and proliferative DR).Methods: A total of 42 patients with severe DR were included in this study and divided into two groups: a severe DR with DME group (DME group, n=18) and a severe DR without DME group (non-DME group, n=24). Ophthalmologic findings and hematologic results were retrospectively retrieved from hospitalization records and databases.Results: The neutrophil percentage was significantly higher in the DME group (62.52%±8.21%) than in the non-DME group (57.30%±8.17%) (P<0.05); in contrast, the lymphocyte percentage was significantly lower in the DME group (28.09%±7.45%) than in the non-DME group (33.54%±7.29%) (P<0.05). Logistic regression analysis showed a significant correlation between lymphocyte percentage and DME [odds ratio (OR) =0.654, 95% CI: 0.436-0.851; P=0.011].Conclusions: Lymphocyte percentage can be used as an inflammatory marker for the development of DME in patients with severe DR.

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The usefulness of systemic inflammatory markers as diagnostic indicators of the pathogenesis of diabetic macular edema

Cited by 13 publications

References 0 publications

Optical Coherence Tomography-Based Grading of Diabetic Macular Edema Is Associated with Systemic Inflammatory Indices and Imaging Biomarkers

Optical Coherence Tomography-Based Grading of Diabetic Macular Edema Is Associated with Systemic Inflammatory Indices and Imaging Biomarkers

Peripheral white blood cell subtypes and the development/progression of diabetic macular edema in type 2 diabetic patients: a comparative study

The relationship between peripheral blood inflammatory markers and diabetic macular edema in patients with severe diabetic retinopathy

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