Short-term impact of glycaemic control and intravitreal ranibizumab treatment on serum cytokine levels and diabetic macular edema in patients with unregulated blood glucose

Year 2022, Volume: 32 Issue: 6, 774 - 780, 31.12.2022

Emine Tınkır Kayıtmazbatır Gülfidan Bitirgen Günhal Şatırtav İbrahim Kılınc Mustafa Kulaksızoğlu Bülent Savut Hürkan Kerimoğlu

https://doi.org/10.54005/geneltip.1191169

Abstract

Objective: To evaluate the short-term effect of glycaemic control and intravitreal ranibizumab treatment on diabetic macular edema (DME) and to assess the correlation between HbA1c and certain serum cytokines.
Design: A prospective study of 43 participants with HbA1c levels exceeding 53 mmol/mol (7%) and with DME, as detected by spectral domain optical coherence tomography (SDOCT).
Subjects: Participants were grouped according to their initial best corrected distance visual acuity (BCVA). Group 1 was treated with three monthly doses of intravitreal ranibizumab (0.5 mg) injections, and Group 2 was followed without treatment.
Methods: Serum cytokine levels, including interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1(MCP-1), and vascular endothelial growth factor (VEGF) were analysed at the beginning and at the end of 3 months, using enzyme-linked immunosorbent assays (ELISA).
Results: A significant decrease in macular thicknesses (except for one quadrant) was observed in Group. Changes in serum cytokine levels were not correlated with HbA1c decrease. Serum VEGF level was significantly increased in Group 1, despite the intravitreal treatment.
Conclusion: Short-term glycaemic control alone had limited value in the treatment of DME. The therapeutic effect of intravitreal treatment on DME supports the role of the local cytokine milieu in the pathophysiology.

Keywords

Diabetes Mellitus, Type 2, Glycaemic Control, Glycated Haemoglobin A1c, Macular Edema, Serum Cytokines, Vascular Endothelial Growth Factor

Supporting Institution

Necmettin Erbakan University Scientific Research Projects Department

Project Number

141518017

Thanks

We thank Samet Uludag, Yusuf Can Efe, and Ihsan Toran from the Department of Ophthalmology for their help in the registration of the participants. We thank Tevfik Balci, M.D., and Nejla Ozer, M.D., from Department of Medical Biochemistry for their collaboration in delivery and storage of the serum samples. We also thank to Fatih Kara, Associate Professor and Adnan Karaibrahimoglu, Assistant Professor for their contribution for statistical analysis of the data.

Kan şekeri regüle olmayan hastalarda kısa dönem glisemik control ve intravitreal ranibizumab tedavisinin serum sitokin düzeyleri ve diyabetik maküler ödem üzerine etkisi

Abstract

Amaç: Glisemik kontrol ve intravitreal ranibizumab tedavisinin diyabetik maküla ödemi (DMÖ) üzerindeki kısa vadeli etkisini ve HbA1c ile belirli serum sitokinleri arasındaki korelasyonu değerlendirmek.
Tasarım: Prospektif çalışmaya HbA1c seviyeleri 53 mmol/mol (%7) üzerinde ve spektral domain optik koherens tomografi (SDOKT) ile DMÖ tespit edilmiş 43 katılımcı dahil edildi.
Katılımcılar: Katılımcılar, başlangıç en iyi düzeltilmiş uzak görme keskinliklerine (EDGK) göre gruplandırıldı. Grup 1, üç doz aylık intravitreal ranibizumab (0.5 mg) enjeksiyonu ile tedavi edilirken, Grup 2’deki katılımcılar intravitreal tedavi uygulanmadan takip edildi.
Yöntem: İnterlökin (IL)-1β, IL-6, IL-8, tümör nekroz faktörü-alfa (TNF-a), monosit kemoatraktan protein-1(MCP-1) ve vasküler endotelyal büyüme faktörü (VEGF) dahil olmak üzere serum sitokin seviyeleri, enzime bağlı immünosorbent testi (ELISA) kullanılarak 3 aylık takibin başında ve sonunda analiz edildi.
Bulgular: Grup 1’in maküla kalınlıklarında (bir kadran hariç) anlamlı azalma gözlendi. Serum sitokin seviyelerindeki değişiklikler HbA1c düşüşü ile korele bulunmadı. Grup 1'de intravitreal tedaviye rağmen serum VEGF düzeyi anlamlı olarak yükseldi.
Sonuç: Kısa süreli glisemik kontrolün tek başına DMÖ tedavisindeki yeri sınırlıdır. İntravitreal tedavinin DMÖ üzerindeki terapötik etkisi, lokal sitokin ortamının patofizyolojideki rolünü desteklemektedir

Keywords

Diyabetes Mellitus, Tip 2, Glisemik Kontrol, Glikolize Hemoglobin A1c, Maküler Ödem, Serum Sitokinleri, Vasküler Endotelyal Büyüme Faktörü

Project Number

141518017

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