Correlation analysis of intraocular fluid and macular microvascular structure in patients with diabetic macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

Gao Jie¹ ¹ , Zhao Zhihui² ² , Pang Huiwen ² , Zhang Feng ² , Sun Lei ² , Sun Fanmin ² , Zhang Weijie ² ,  Wang Tao ²

1. School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, China;
2. Department of Ophthalmology, Linyi Third People's Hospital, Linyi 276002, China;
Zhao Zhihui, Studying Doctor, is working in Department of Ophthalmology, Linyi People's Hospital, Linyi 276002, China; Zhang Weijie, Studying Nurse, is working in Linyi Central Hospital, Linyi 276400, China; Sun Fanmin, Graduate student, is working in Linyi Central Hospital, Linyi 276400, China;

Corresponding author：

Wang Tao, Email: wtandren@sina.com

Keywords：

Intraocular fluid test; Diabetic macular edema; Macular microvascular structure; Optical coherence tomography; Optical coherence tomography angiography

DOI：

10.3760/cma.j.cn511434-20241113-00425

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Objective To observe and analyze the correlation between the level of intracocular fluid cytokines and the changes of macular microvascular structure in patients with diabetic macular edema (DME). Methods A prospective clinical study. From December 2022 to June 2024, 20 patients with 25 eyes of DME diagnosed by Department of Ophthalmology of Linyi People's Hospital were included in the study. Among them, 14 males had 17 eyes and 6 females had 8 eyes. Age was (55.08±10.34) years. Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to scan the macular region at a range of 6 mm×6 mm. Central retinal thickness (CRT), blood flow density of superficial retinal capillary plexus (SCP) and area of avascular fovea of macula (FAZ) were measured. The anterior aqueous humor was extracted before the first intravitreal injection of anti-vascular endothelial growth factor (VEGF), the concentrations of interleukin (IL-6), IL-8, VEGF, vascular cell adhesion molecule (VCAM), placental growth factor (PLGF) and monocyte chemotactic protein-L (MCP-1) were detected. The correlation between macular microvascular structure and aqueous humor cytokines was analyzed by Spearman correlation analysis. Results The CRT of the affected eyes was (617.40±167.64) μm, the SCP flow density was (39.56±1.55)%, and the FAZ area was (0.46±0.13) mm². The concentrations of IL-6, IL-8, VEGF, VCAM, PLGF and MCP-1 in aqueous humor were (301.36±690.52), (29.15±20.56), (71.37±29.32) and (5 621.22±7 241.06), (72.40±13.43), (464.07±163.26) pg/ml, respectively. Correlation analysis showed that there was a significant positive correlation between CRT and the concentrations of aqueous cytokines VEGF and PLGF (r=0.460, 0.462, P＜0.05). FAZ area was positively correlated with VEGF and MCP-1 concentrations (r=0.414, 0.465; P＜0.05). There was a significant negative correlation between SCP blood flow density and IL-6 (r=0.401, P＜0.05). Conclusion There was a significant correlation between the concentration of aqueous cytokines in DME patients and the morphological structure of macular area and the damage degree of microvessels around macular area.

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1. Zhang G, Chen H, Chen W, et al. Prevalence andrisk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study[J]. Br J Ophthalmol, 2017, 101(12): 1591-1595. DOI: 10.1136/bjophthalmol-2017-310316.
2. 邓宇轩, 叶雯青, 孙艳婷, 等. 中国糖尿病视网膜病变患病率的荟萃分析[J]. 中华医学杂志, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.Deng YX, Ye WQ, Sun YT, et al. A meta-analysis of prevalence of diabetic retinopathy in China[J]. Natl Med J China, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.
3. Tang FY, Chan EO, Sun Z, et al. Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes[J]. Eye Vis (Lond), 2020, 7(1): 7. DOI: 10.1186/s40662-019-0173-y.
4. 黄海燕, 李德爽, 谷浩, 等. OCT和OCTA生物学标志物在糖尿病性黄斑水肿预后和监测中的应用[J]. 国际眼科杂志, 2024, 24(5): 743-748. DOI: 10.3980/j.issn.1672-5123.2024.5.15.Huang HY, Li DS, Gu H, et al. Application of optical coherence tomography and optical coherence tomography angiography biomarkers in the prognosis and monitoring of diabetic macular edema[J]. Int Eye Sci, 2024, 24(5): 743-748. DOI: 10.3980/j.issn.1672-5123.2024.5.15.
5. 陶勇. 眼内液病原学检测的研究进展[J]. 中华眼科杂志, 2018, 54(7): 551-556. DOI: 10.3760/cma.j.issn.0412-4081.2018.07.019.Tao Y. Research on examination of intraocular fluid for diagnosis of infectious ocular diseases[J]. Chin J Ophthalmol, 2018, 54(7): 551-556. DOI: 10.3760/cma.j.issn.0412-4081.2018.07.019.
6. 许畅, 毛晓春. 正常人黄斑中央凹无血管区域面积分析[J]. 国际眼科杂志, 2017, 17(3): 499-503. DOI: 10.3980/j.issn.1672-5123.2017.3.28.Xu C, Mao XC. Foveal avascular zone area in normal subjects[J]. Int Eye Sci, 2017, 17(3): 499-503. DOI: 10.3980/j.issn.1672-5123.2017.3.28.
7. Yokoyama T, Maruko I, Koizumi H, et al. Unmeasurable small size of foveal avascular zone without visual impairment in optical coherence tomography angiography[J]. Eye (Lond), 2018, 32(6): 1062-1066. DOI: 10.1038/s41433-017-0005-z.
8. Takase N, Nozaki M, Kato A, et al. Enlargement of foveal avascular zone in diabetic eyes evaluated by en face optical coherence tomography angiography[J]. Retina, 2015, 35(11): 2377-2383. DOI: 10.1097/IAE.0000000000000849.
9. Sorour OA, Sabrosa AS, Alibhai AY, et al. Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy[J]. Int Ophthalmol, 2019, 39(10): 2361-2371. DOI: 10.1007/s10792-019-01076-x.
10. Wu H, Hwang DK, Song X, et al. Association between aqueous cytokines and diabetic retinopathy stage[J/OL]. J Ophthalmol, 2017, 2017: 9402198[2017-06-07]. https://pubmed.ncbi.nlm.nih.gov/28680705/. DOI: 10.1155/2017/9402198.
11. Feng S, Yu H, Yu Y, et al. Levels of inflammatory cytokines IL-1β, IL-6, IL-8, IL-17A, and TNF-α in aqueous humour of patients with diabetic retinopathy[J/OL]. J Diabetes Res, 2018, 2018: 8546423[2018-04-04]. https://pubmed.ncbi.nlm.nih.gov/29850610/. DOI: 10.1155/2018/8546423.
12. Wu J, Zhong Y, Yue S, et al. Aqueous humor mediator and cytokine aberrations in diabetic retinopathy and diabetic macular edema: a systematic review and meta-analysis[J/OL]. Dis Markers, 2019, 2019: 6928524[2019-11-23]. https://pubmed.ncbi.nlm.nih.gov/31871502/. DOI: 10.1155/2019/6928524.
13. Holmes DI, Zachary I. The vascular endothelial growth factor (VEGF) family: angiogenic factors in health and disease[J]. Genome Biol, 2005, 6(2): 209. DOI: 10.1186/gb-2005-6-2-209.
14. Tamhane M, Cabrera-Ghayouri S, Abelian G, et al. Review of biomarkers in ocular matrices: challenges and opportunities[J]. Pharm Res, 2019, 36(3): 40. DOI: 10.1007/s11095-019-2569-8.
15. Oh IK, Kim SW, Oh J, et al. Inflammatory and angiogenic factors in the aqueous humor and the relationship to diabetic retinopathy[J]. Curr Eye Res, 2010, 35(12): 1116-1127. DOI: 10.3109/02713683.2010.510257.

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