Study of aqueous humour inflammatory mediators' levels in a cohort of Egyptian patients with diabetic macular oedema.

BACKGROUND: The aim was to study aqueous humour inflammatory mediators' levels in a cohort of Egyptian patients with diabetic macular oedema (DMO). METHODS: This was a case-control prospective study conducted on 2 groups: 25 eyes of 22 (11 females) patients seeking treatment for DMO as patients group, and 10 eyes of 10 (4 females) cataract patients as a control group. Aqueous humour was aspirated before intravitreal injection (patients' group) or cataract surgery (control group). Inflammatory mediators in aqueous humour were measured using a multiplex bead immunoassay kit of 27 pre-mixed cytokines. RESULTS: Eotaxin, interferon gamma-induced protein 10 (IP-10), monocyte chemoattractant protein-1 (MCP-1/CCL2) and interleukin-8 (IL-8/CXCL8) were found significantly higher in patients' group compared to control group (p = 0.043, 0.037, 0.001, 0.015 respectively). On the contrary, interferon-gamma (IFN-gamma) and granulocyte colony-stimulating factor (G-CSF) were found significantly higher in control group than patients' group (p = 0.003, 0.019 respectively). Basic fibroblast growth factor (Basic-FGF/FGF-2) and interleukin-1 receptor antagonist (IL-1ra) were found higher (but not statistically significant) in controls (p = 0.100 and 0.070 respectively). Additionally, a negative and significant correlation was found between Eotaxin level in aqueous humour and central macular thickness. CONCLUSIONS: Some mediators might be implicated in the pathogenesis of DMO either augmenting or suppressing role. Eotaxin, IP-10, MCP-1 and IL-8 might have a role in cases not responding to standard anti-vascular endothelial growth factor (VEGF) therapy. IL-1ra might have a protective role; therefore, the effectiveness of intravitreal injection of IL-1ra homologue needs to be studied in future clinical trials.

One-year results of switching to aflibercept for persistent diabetic macular edema resistant to bevacizumab.

PURPOSE: The aim of this study is to evaluate the functional and anatomical effects of switching from bevacizumab to aflibercept in patients with persistent diabetic macular edema (DME) resistant to bevacizumab. MATERIALS AND METHODS: Patients with DME refractory to bevacizumab (1.25 mg/0.05 mL) were subsequently switched to aflibercept. The included patients received five loading doses of intravitreal aflibercept (2 mg/0.05 mL) given monthly. After the loading dose, aflibercept was injected every 2 months. The follow-up duration was 1 year. RESULTS: The study consisted of 37 eyes of 37 patients. The mean age of the participants was 56.81 ± 7.11 years. The mean central macular thickness at baseline was 428.32 ± 84.89 µm, which decreased significantly to 275.54 ± 50.24 µm (P < 0.003). There was a significant improvement in the mean best-corrected logMAR visual acuity from 0.627 ± 0.307 at baseline to 0.203 ± 0.235 (P < 0.017) at the end of follow-up. CONCLUSIONS: Aflibercept is effective in patients with persistent DME not responsive to bevacizumab.

Pars Plana Vitrectomy versus Intravitreal Injection of Ranibizumab in the Treatment of Diabetic Macular Edema Associated with Vitreomacular Interface Abnormalities.

PURPOSE: To compare the efficacy of pars plana vitrectomy (PPV) versus intravitreal injection (IVI) of ranibizumab (RBZ) in the treatment of diabetic macular edema (DME) associated with vitreomacular interface abnormalities (VMIA). METHODS: The records of patients presenting with DME and VMIA throughout 2016 to 2018 were retrospectively analyzed. The patients were divided into 2 groups: group I received IVIs of RBZ and group II underwent PPV with internal limiting membrane peeling. The main outcome measures were the change in the LogMAR corrected distance visual acuity (CDVA) and central subfield thickness (CSFT) on optical coherence tomography over 6 months. RESULTS: At 6 months, mean CDVA improved by 0.22 ± 0.21 in group I patients (p < 0.001), while in group II, it improved only by 0.09 ± 0.22 (p < 0.115). Fifty-five percent of group I and 60% of group II patients had stable CDVA (within 2 lines from baseline) at 6 months. Significant improvement in vision (gain of 2 or more lines) was seen in 45% and 30%, respectively. Worsening of vision (loss of 2 or more lines) was seen only in 2 patients in group II, but none in group I. The mean CSFT improved significantly in both groups (by 162 µ and 216 µ, respectively; p < 0.001). The mean CSFT at 6 months was similar in both groups (354 µ and 311 µ, respectively; p=0.172). CONCLUSIONS: Both treatments resulted in anatomical improvement of DME with concurrent VMIA. Visual improvement was more pronounced in the IVI group, although this may have been affected by other confounding factors.

Aflibercept plus micropulse laser versus aflibercept monotherapy for diabetic macular edema: 1-year results of a randomized clinical trial.

PURPOSE: To evaluate the role of adjuvant micropulse laser with aflibercept injections in the management of treatment naive center involving DME, looking at decreased treatment burden and increased efficacy as outcomes after 1 year. METHODS: This was a prospective, single center, randomized trial that included 40 eyes (40 patients) with previously untreated center involved DME. Patients were randomly assigned to receive either aflibercept plus micropulse laser (group A) or aflibercept monotherapy (group B). RESULTS: Overall, 40 patients were included in the study; they were randomized into either group A (aflibercept + micropulse; 20 patients) or group B (aflibercept monotherapy; 20 patients). The mean number of injections after the loading dose was 4.5 ± 1.4 in group A and was 5.4 ± 1.7 in group B, and the difference between both groups was statistically significant (P = 0.029). CONCLUSION: Adding 577-nm micropulse laser to aflibercept is effective for treatment naïve DME and is associated with decreased number of injections.

MicroRNA-200b Expression in the Vitreous Humor of Patients with Proliferative Diabetic Retinopathy.

BACKGROUND: The role of microRNA (miRNA)-200b in the pathogenesis of proliferative diabetic retinopathy (PDR) has been studied in diabetic animal models. The aim of this study was to assess miRNA-200b expression in the vitreous of patients with PDR and to determine its correlation with vascular endothelial growth factor (VEGF), one of the pathogenic mechanisms in PDR. METHODS: Quantitative reverse transcription polymerase chain reaction was used to measure miRNA-200b expression in the vitreous from 29 eyes with PDR and 30 eyes with idiopathic macular holes (IMH; control group). Vitreous VEGF was measured using an enzyme-linked immunosorbent assay. RESULTS: miRNA-200b expression was about 5-fold increased in the vitreous samples from eyes with PDR compared with the controls (p ≤ 0.001). Vitreous VEGF expression was also significantly higher in the PDR group than in the IMH group (p ≤ 0.001), but no significant correlation was found between miRNA-200b and VEGF. CONCLUSION: Both miRNA-200b and VEGF are increased in the vitreous of patients with PDR but in a noncorrelated pattern. miRNA-200b may be involved in the pathogenesis of PDR but through VEGF-independent mechanisms. Further studies are needed to identify the miRNA-200b-targeted genes involved in the pathogenesis of PDR and to examine the potential role of miRNA-200b as a target for PDR treatment.

The vitreomacular interface in different types of age-related macular degeneration.

AIM: To evaluate the vitreomacular interface in cases with wet age-related macular degeneration (AMD) and to compare them to eyes with dry AMD and normal eyes. METHODS: This was a cross-sectional comparative study that included 87 eyes with wet AMD, 42 eyes with dry AMD and 40 eyes without AMD as a control group. Optical coherence tomography (OCT) examination was performed for all patients to assess the vitreomacular interface. RESULTS: In the wet AMD group, 34.5% of cases had vitreomacular adhesion (VMA). Only 14.3% of dry AMD cases and 10% of control cases had VMA. There was a significant difference between the control group and the wet AMD group (P=0.004) as well as the dry and wet AMD group (P=0.017). There was also a significant difference between the incidence of VMA in patients with subretinal choroidal neovascularization (CNV, type 1) and intraretinal CNV (type 2 or type 3) (P=0.020). CONCLUSION: There is an association between posterior vitreous attachment and AMD. There is also an increased incidence of VMA with intra-retinal CNV.

Applying Sutureless Encircling Number 41 Band and Transscleral Chandelier-Assisted Laser Retinopexy for Scleral Buckling Procedure.

PURPOSE: To assess the outcome of sutureless encirlcing number 41 band and transscleral laser retinopexy in uncomplicated rhegmatogenous retinal detachment (RRD), using a wide-angle viewing system (WAVS) and chandelier endoillumination. METHODS: Prospective intervention study included 30 eyes of 30 patients presenting with RRD of recent onset indicated for SB. All cases were treated by sutureless encircling number 41 band and transscleral laser retinopexy. Visualization was provided by the Resight WAVS and a single 27-gauge chandelier endoillumination. Anatomical and visual outcomes were evaluated. RESULTS: The mean age of our group was 49.8 ± 12.3 years, and the mean duration of RD was 7 (0-50) days. Twenty-four eyes (80.0%) were phakic while the remaining 6 eyes (20%) were either pseudophakic or aphakic. The primary retinal reattachment rate was 83.3% (25 out of 30 eyes). LogMAR visual acuity improved from 1.3 (0.30-2.0) preoperatively to 1.0 (0.40-1.60) at first month (p = 0.002) and to 0.70 (0.20-1.92) at third month (p < 0.001). CONCLUSION: Sutureless encircling number 41 band with chandelier-assisted transscleral laser retinopexy is a safe and effective technique for managing uncomplicated RRD. It provides a high primary success rate while eliminating the complications of cryotherapy, sutures, and broad buckles.