视网膜静脉阻塞继发黄斑水肿抗VEGF治疗后OCTA指标变化与基线房水细胞因子的相关性分析

Correlation between baseline aqueous humor cytokines and optical coherence tomography angiography changes after anti-vascular endothelial growth factor treatment for macular edema secondary to retinal vein occlusion

目的探讨视网膜静脉阻塞继发黄斑水肿(RVO-ME)患者抗血管内皮生长因子(VEGF)治疗后光学相干断层扫描血管成像(OCTA)指标变化与基线房水细胞因子的关系。方法纳入2021年10月至2023年1月在南京医科大学眼科医院确诊为RVO-ME的患者30例30眼,均采用3+PRN方案的玻璃体内注射抗VEGF药物。分别收集第1次和第3次注射前的房水,采用Luminex液相芯片技术测定VEGF、白细胞介素(IL)、γ-干扰素(IFN-γ)、细胞间黏附分子-1(ICAM-1)和血小板源性生长因子(PDGF)等细胞因子的表达水平。利用OCTA测量黄斑中心凹视网膜厚度(CMT)、黄斑中心凹无血管区(FAZ)面积、周长(PERIM)、非圆度指数(AI)、FAZ范围300μm宽度内的血管密度(FD-300)。采用国际标准对数视力表检查最佳矫正视力(BCVA),并换算为最小分辨角对数(logMAR)视力。比较RVO-ME患者抗VEGF治疗前后房水中细胞因子表达水平和OCTA指标的变化,分析治疗后OCTA指标变化与基线房水细胞因子的关系。结果RVO-ME患者患眼治疗后房水细胞因子中VEGF、ICAM-1、PDGF、IL-8、IL-10表达水平均下降,差异均有统计学意义(均为P<0.05);治疗后BCVA改善(P<0.001),CMT、AI及FD-300指标均下降,差异均有统计学意义(均为P<0.05)。相关性分析结果显示,基线IL-13水平与AI变化值呈负相关(r=-0.388,P<0.05);基线IL-8水平与FD-300变化值呈负相关(r=-0.421,P<0.05)。结论基线房水细胞因子IL-13和IL-8可能与RVO-ME患眼抗VEGF治疗后视网膜黄斑区微血管结构改善程度有关。针对RVO-ME的治疗与管理不应局限于抗血管治疗,还应针对性进行抗炎治疗。

Objective To investigate the relationship between baseline aqueous humor cytokines and optical coherence tomography angiography(OCTA)changes in eyes with macular edema secondary to retinal vein occlusion(RVO-ME)after anti-vascular endothelial growth factor(VEGF)treatment.Methods From October 2021 to January 2023,30 eyes of 30 patients diagnosed with RVO-ME at the Affiliated Eye Hospital of Nanjing Medical University were included in this study.All eyes were treated with the intravitreal injection of anti-VEGF drugs once a month for 3 consecutive months and then treated as needed.The aqueous humors before the first and third injections were collected.The expression levels of VEGF,interleukins(IL),γ-interferon(IFN-γ),intercellular adhesion molecule-1(ICAM-1),and platelet-derived growth factor(PDGF)were detected using the Luminex platform.The central macular thickness(CMT),fovea avascular zone(FAZ)area,perimeter(PERIM),acircularity index(AI),and the vessel density in a 300μm wide region around FAZ(FD-300)were measured using OCTA.The best corrected visual acuity(BCVA)was examined using the international standard logarithmic visual acuity chart,which was converted into the logarithm of the minimum angle of resolution(logMAR)for statistics.Aqueous humor cytokines and OCTA parameters were compared before and after anti-VEGF treatment for RVO-ME,and the relationship between OCTA changes(the difference between before and after treatment)and baseline aqueous humor cytokines was analyzed.Results After treatment,the levels of VEGF,ICAM-1,PDGF,IL-8,and IL-10 in RVO-ME patients decreased(all P<0.05),the BCVA improved(P<0.001),and CMT,AI and FD-300 decreased(all P<0.05).Correlation analysis results showed that baseline IL-13 was negatively correlated with the AI change(r=-0.388,P<0.05),and baseline IL-8 was negatively correlated with the FD-300 change(r=-0.421,P<0.05).Conclusion Baseline IL-13 and IL-8 may be related to the improvement of the retinal macular microvascular structure after anti-VEGF treatment for RVO-ME.For the treatment and management of RVO-ME,in addition to anti-VEGF therapy,targeted anti-inflammatory therapy should also be considered.