Idiopathic Choroidal Neovascularization: Intraocular Inflammatory Cytokines and the Effect of Intravitreal Ranibizumab Treatment

Abstract

Idiopathic choroidal neovascularization (ICNV) is a disorder that primarily affecting patients younger than 50 years and can cause severe loss of vision. Choroidal abnormalities, especially choroidal inflammation, have been thought to be involved in the pathophysiology of ICNV. However, the exact pathogenesis of ICNV remains unclear. The aim of our study was investigate the levels of 27 inflammatory cytokines in the aqueous humor of eyes with ICNV, and to determine the effect of intravitreal injection of ranibizumab (IVR) on cytokine levels. Significantly higher levels of IL-2, IL-10, IL-15, IL-17, basic FGF, and GM-CSF were observed in patients with ICNV compared with controls. However, only IL-17 levels were significantly higher in patients with ICNV compared with controls after adjusting for axial length. Furthermore, there were significant correlations between the levels of IL-10, IL-17, GM-CSF, and VEGF and the lesion area. Significant changes in visual acuity and central retinal thickness were observed after IVR. Besides VEGF, IVR also significantly reduced the levels of IL-2, IL-10, basic FGF, and IL-12, however, the IL-6 levels were significantly increased. Our results suggest that there may be an involvement of IL-17-related inflammatory processes in the etiology of ICNV.

Retinal and choroidal angiogenesis: a review of new targets

“…In eyes with choroidal neovascularization, elevated IL-17 was detected in aqueous humor when compared with the control group, leading to the hypothesis that this cytokine may stimulate angiogenesis in a VEGF-independent manner [ 103 ]. IL-10 is another interleukin that can promote pathological neovascularization [ 104 ].…”

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization

“…This was consistent with the study by Sudhalkar A et al [16] which showed that patients with a higher baseline BCVA had a better prognosis. These findings might relate to the high permeability of neovascular structures, which could cause bleeding and exudation and induce inflammatory reactions and retinal damage [5,22]. ICNV patients with a good baseline BCVA might not suffer from irreversible inflammatory effects and retinal damage; therefore, our results suggest that timely anti-VEGF treatment can effectively reduce the inflammatory response and make CNV lesions subside, in turn leading to a better prognosis.…”

“…It has been suggested that when abnormal blood vessels originating from the choriocapillaris break through the Bruch membrane and grow in the retinal pigment epithelium (RPE) or infiltrates into the subretinal pigment epithelium or subretinal space [2,3], they can result in CNV. CNV that develops in younger patients who are less than 50 years old is usually attributed to pathologic myopia, angioid streaks, trauma, cytomycosis, central serous chorioretinopathy (CSC) and other hereditary ocular diseases [4,5]. However, the cause of CNV still remains unclear in a large number of younger patients.…”

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization

“…This was consistent with the study by Sudhalkar A et al (16) which showed that patients with a higher baseline BCVA had a better prognosis. These findings might relate to the high permeability of neovascular structures, which could cause bleeding and exudation and induce inflammatory reactions and retinal damage (5,22). ICNV patients with a good baseline BCVA might not suffer from irreversible inflammatory effects and retinal damage; therefore, our results suggest that timely anti-VEGF treatment can effectively reduce the inflammatory response and make CNV lesions subside, in turn leading to a better prognosis.…”

“…CNV that develops in younger patients who are less than 50 years old is usually attributed to pathologic myopia, angioid streaks, trauma, cytomycosis, central serous chorioretinopathy (CSC) and other hereditary ocular diseases (4,5). However, the cause of CNV still remains unclear in a large number of younger patients.…”