Association of preoperative vitreous IL‐8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy

Abstract

Acta Ophthalmol. 2010: 88: e311–e316 Abstract. Purpose: To determine whether the vitreous levels of interleukin 8 (IL‐8) and vascular endothelial growth factor (VEGF) of patients with proliferative diabetic retinopathy (PDR) were associated with poor visual acuity after vitrectomy. Methods: Observational cross‐sectional study. Patient clinical characteristics and preoperative eye characteristics (63 eyes): visual acuity, iris neovascularization, vitreous haemorrhage, macular detachment, macular oedema, active retinal neovascularization, neovascularization of the disc, burned out PDR (defined as natural end stage of PDR with inactive membranes without previously performed laser photocoagulation) and panretinal photocoagulation were registered prior to vitrectomy for each patient. Vitreous VEGF and IL‐8 levels were measured using the cytometric bead array method. Poor postoperative visual acuity was defined as visual acuity of <20/200 and was checked 2 years after vitrectomy. Results: Twenty‐one of the 63 eyes (33.3%) had poor visual acuity after vitrectomy. Univariate analysis showed that vitreous levels of IL‐8, the absence of panretinal photocoagulation, preoperative macular detachment and poor preoperative visual acuity were significantly associated with poor final visual acuity after vitrectomy. A stepwise multiple logistic regression analysis showed that elevated vitreous levels of IL‐8 (p < 0.0001), macular detachment (p = 0.011) and the absence of panretinal photocoagulation (p = 0.03) were independent predictors for poor visual outcome. Conclusions: Elevated vitreous IL‐8 level could either be a marker of ischaemic inflammatory reaction, or it could play a role in deteriorating visual acuity by DR progression or both. Further studies are needed to provide better understanding of IL‐8 and inflammation involvement in visual prognosis in PDR.

Macular morphologic findings on optical coherence tomography after microincision vitrectomy for proliferative diabetic retinopathy

“…Indeed, we did not identify preoperative factors predictive of the visual outcomes in this study, although several ocular and systemic prognostic factors have been reported [38][39][40][41]. We did show for the first time the clinical relevance of a disrupted ellipsoid zone or ELM on SD-OCT images after MIVS for vitreous hemorrhage due to PDR, suggesting the potential utility of SD-OCT examination after surgery.…”

Role of Intravitreal Inflammatory Cytokines and Angiogenic Factors in Proliferative Diabetic Retinopathy

“…34 VEGF was found elevated in the vitreous of our patients with PDR, which is in accordance with previous findings. [13][14][15][16]25,26,28,34 IL6 is a multifunctional cytokine that indirectly causes an increase in vascular permeability and neovascularization by inducing the expression of VEGF, and also directly increases endothelial cell permeability in vitro by rearranging actin filaments and by changing the shape of endothelial cells. 35 Serum and vitreous levels of IL-6 may have a role in PDR.…”

“…Interleukins play an important role in the regulation of immune mechanisms. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] ABSTRACT Objective: Inflammatory reaction has been shown to involve the progress of type 2 (non-insulin-dependent) diabetes. We, therefore, examined the effects of inflammatory cytokines and angiogenic factors in the pathogenesis of proliferative diabetic retinopathy (PDR) in type 2 diabetes.…”

Diabetic retinopathy and inflammation: Novel therapeutic targets

“…have shown that the levels of IL-6, IL-8 (CXCL8), IL-10 (CXCL10), IL-13, IP-10, MCP-1(CCL2), MIP-1β (CCL4), PDGF, and VEGF in the vitreous fluid are significantly higher in any sign of a diabetic retinopathy group 53. Studies have shown that the elevated vitreous IL-8 levels in diabetic subjects are associated with deteriorating visual acuity in diabetic retinopathy 54. Elevation of the aqueous concentration of MCP-1 / CCL2, IP-10, and IL-8 levels in eyes with severe NPDR suggests that inflammatory changes precede the development of neovascularization in PDR 55.…”

“…The important observation one can infer from the above set of studies are: (1) There are common sets of inflammatory cytokines that are upregulated in both serum and vitreous / aqueous samples in subjects with retinopathy, (2) the same kind of cytokines are involved in the pathogenesis of both PDR and NPDR [Table 2] and these cytokines can have multiple interactions to impact the pathogenesis of diabetic retinopathy 545559. Despite the important function of VEGF as an angiogenic and inflammatory factor, studies have observed that a selective blocking of VEGF using bevacizumab injections (anti-VEGF) has no influence on the control of other immunogenic cytokines, such as, MCP-1 and IL-6, in the aqueous humor of DME 60.…”