Retinal Morphologic Changes and Concentrations of Cytokines in Eyes With Diabetic Macular Edema

Sonoda, Shozo; Sakamoto, Taiji; Yamashita, Takehiro; Shirasawa, Makoto; Otsuka, Hiroki; Sonoda, Yoshito

doi:10.1097/iae.0b013e3182a48917

Cited by 99 publications

(106 citation statements)

References 38 publications

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“…In particular, inflammatory cytokines may have more important roles than VEGF in eyes with DMO resistant to serial anti-VEGF injections; past studies have shown that although VEGF is correlated with the severity of diabetic retinopathy, no significant correlation was shown between VEGF level and DMO, whereas inflammatory factors such as IL-6 and MCP-1 have shown significant correlation with DMO. [33][34][35][36][37] This may explain the favorable morphological improvement in our study of CT and CFT to IVD, in eyes with refractory DMO.…”

Section: Discussionsupporting

confidence: 49%

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Kim

Cho

Lee

et al. 2016

Eye

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Aims To investigate the effect of intravitreal dexamethasone implant (IVD) on central foveal thickness (CFT), choroidal thickness (CT) and its correlation with visual acuity in eyes with refractory diabetic macular oedema (DMO). Methods This was a retrospective interventional case-series. Thirty-five eyes of 35 patients were treated with a single injection of IVD because of refractory DMO with CFT over 300 μm, and persistent intraretinal and subretinal fluid despite of multiple intravitreal bevacizumab injections. Patients were followed-up for 6 months for the evaluation of CFT and subfoveal CT by spectral-domain optical coherence tomography. Results All eyes (mean age: 59.4 ± 12.35 years; 18 males, 17 females) had been previously treated with multiple bevacizumab injections and showed persistent DMO (mean number of injections 4.08 ± 2.98) The preoperative logMAR BCVA was 0.49 ± 0.24, which gradually improved to 0.46 ± 0.32 at 6 months (P = 0.652) and 26% gained two or more lines of Snellen visual acuity. At baseline, the mean CFT was 526.29 ± 123.48 μm, which significantly improved to 316.15 ± 100.09 μm at 3 months (Po0.001). However, CFT deteriorated to 457.07 ± 136.53 μm at 6 months (P = 0.051). Similarly, the mean preoperative subfoveal CT was 288.91 ± 36.47 μm and it decreased to 266.85 ± 30.93 μm at 3 months (Po0.01), but increased to 278.63 ± 32.55 μm at 6 months (P = 0.137). The reduction of CFT from baseline showed significant correlation with that of subfoveal CT at 3 months (P = 0.041) and at 6 months (P = 0.008). Conclusions In DMO refractory to multiple bevacizumab injections, IVD significantly reduced CFT and subfoveal CT, with BCVA improvement in one-fourth of the patients. The reduction of CFT showed significant correlation with reduction of subfoveal CT.

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Section: Discussionsupporting

confidence: 49%

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Kim

Cho

Lee

et al. 2016

Eye

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“…Levels of IL-6 were shown to be increased in the eyes of patients with DR, particularly in proliferative stages of the disease [32, 33]. Recently, higher concentrations of inflammatory cytokines in the vitreous and aqueous humor have been reported in eyes with SRD, thus suggesting the presence of a significant inflammatory component [5, 9, 10, 30]. Indeed, high serum IL-6 level was found to be associated with severe grades of DR itself [11].…”

Section: Discussionmentioning

confidence: 99%

“…The main contributor to DME development has been thought to be the intraocular production of proinﬂam matory cytokines such as IL-6, IL-8, TNF-α, IL-1β, VEGF, pigment epithelium-derived factor, ICAM-1, and monocyte chemotactic protein (MCP-1) [9, 10, 24, 25]. There are very few data with regard to the altered levels of inflammatory mediators in peripheral blood of DME patients, in contrast to those mediators in intraocular blood [9, 11].…”

Section: Discussionmentioning

confidence: 99%

“…Higher intravitreal levels of IL-6 were shown to be correlated with SRD [5]. Sonoda et al [10] reported that intravitreal IL-6 was the most signiﬁcantly related factor for SRD. As a multifunctional cytokine, IL-6 is known to play essential roles in regulating immune processes with regard to both increased vascular permeability and angiogenesis [12].…”

Section: Introductionmentioning

confidence: 99%

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A Novel Biomarker in Diabetic Macular Edema with Serous Retinal Detachment: Serum Chitinase-3-Like Protein 1

Kaya

İdıman

et al. 2018

Ophthalmologica

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Purpose: To determine whether serum chitinase-3-like protein 1 (CHI3L1) and interleukin-6 (IL-6) levels correlate with serous retinal detachment (SRD) in diabetic macular edema (DME) using spectral-domain optical coherence tomography (SD-OCT). Methods: In this cross-sectional case-control study, 394 patients (treatment-naive DME patients, n = 218; diabetic patients without DME, n = 96; nondiabetic controls, n = 80) were included in the study. Eyes were classiﬁed according to SD-OCT features of DME: SRD, cystoid macular edema (CMO), and diffuse retinal thickness (DRT). Serum concentrations of CHI3L1 and IL-6 were analyzed using enzyme-linked immunosorbent assay. Results: Serum CHI3L1 and IL-6 levels were significantly higher in DME with SRD compared to patients with CMO and DRT (p < 0.001 for all groups). Multivariate regression analysis showed that CHI3L1 and IL-6 had a stronger influence on the presence of SRD in DME (r = 1.162, p = 0.026, and r = 1.242, p = 0.016, respectively). Serum concentration of CHI3L1 was significantly correlated with that of IL-6 (r = 0.386, p = 0.0015). Conclusions: Our data suggest that serum concentrations of CHI3L1 and IL-6 are involved in the process of SRD in DME. CHI3L1 can be investigated further as a new diagnostic biomarker for DME with SRD.

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“…Among patients with DME, those with serous subretinal detachment have the worst visual prognosis after therapy and this seems to be related to the interruption of ELM and EZ zones [29] . ELM disruption with subsequent microglial cell attraction has been hypothesized, and this could explain the higher concentration of intravitreal inflammatory cytokines in eyes with subretinal detachment [30] . Different patterns of increased foveal fundus autofluorescence have been reported in DME and this could be explained by the accumulation of oxidative products induced by activated microglial cells [31][32][33] .…”

mentioning

confidence: 99%

Emerging Issues for Optical Coherence Tomography

Pierro¹,

Rabiolo²

2017

Management of Diabetic Retinopathy

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Almost 25 years after its introduction, optical coherence tomography (OCT) is still a crucial test in the evaluation of patients affected by diabetic retinopathy. In this chapter, the authors provide an extensive overview of the posterior segment pathological changes induced by diabetes, characterized using OCT. OCT plays a key role in diabetic macular edema (DME) as it assesses related retinal changes both in a qualitative (i.e., DME pattern, presence and aspects of cysts, fluid localization, integrity, and reflectivity of retinal layers) and quantitative (i.e., macula volume, central and sectorial retinal thickness) way, and it is therefore essential for diagnosis, characterization, and follow-up of DME. Diabetic macular ischemia is associated with retinal structural changes which can be investigated using OCT, although its diagnosis relies mostly on fluorescein angiography. Beyond DME and macular ischemia, OCT permits the individuation of many other lesions occurring in the setting of both non-proliferative (i.e., hyperreflective spots, micropseudocysts, hard exudates, microaneurysm, cotton-wool spots) and proliferative (i.e., neovascularization, vitreoschisis, tractional retinal detachment, hemorrhage) retinopathies. OCT provides precious information on several structures, including vitreo-retinal interface, retinal nerve fiber layers, ganglion cell complex, and choroid.

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Retinal Morphologic Changes and Concentrations of Cytokines in Eyes With Diabetic Macular Edema

Abstract: The significant association of SRD with intravitreal IL-6 indicates that inflammation may play an important role in the development of SRD in diabetic macular edema.

Cited by 99 publications

References 38 publications

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

A Novel Biomarker in Diabetic Macular Edema with Serous Retinal Detachment: Serum Chitinase-3-Like Protein 1

Emerging Issues for Optical Coherence Tomography

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