ENTER


Полный размерЗакрыть
Details


https://doi.org/10.30702/Ophthalmology.2019/10.126575

Panchenko Iu. O.

Kyiv City Clinical Ophthalmological Hospital “Eye Microsurgery Center”, Kyiv, Ukraine Medical Center “LASER Plus”, Lviv, Ukraine

 

Abstract

Background. The search for relapses risk and prognosis factors in the surgical treatment of diabetic maculopathy (DMP) in patients with type 2 diabetes mellitus (T2DM) is very important. In this regard, our attention was drawn to an important pathogenetic factor of DMP – tumor necrosis factor-alpha (TNFα).

Aim. To study the relationship of TNFα with DMP relapse after its surgical treatment using various options for vitreoretinal interventions in patients with T2DM.

Materials and methods. We observed 313 patients with T2DM (313 eyes) with DMP and initial (group 1; n = 40), moderate or severe non-proliferative diabetic retinopathy (NPDR; group 2; n = 92) and proliferative diabetic retinopathy (PDR; group 3; n = 181). Four types of surgical interventions were used in patients: 78 patients underwent three-port closed subtotal vitrectomy; 85 patients underwent peeling of the inner limiting membrane in addition to these methods; 81 patients additionally received panretinal laser coagulation; cataract phacoemulsification was additionally performed in 69 patients. Prior to surgery, TNFα blood levels were determined by enzyme-linked immunosorbent assay. The control group consisted of 95 people. For statistical data processing, the program Statistica 10 (StatSoft, Inc., USA) was used.

Results. Before surgery the blood TNFα level was increased according to the severity of retinopathy: in group 1, the TNFα level exceeded the control group level by 1.2 (p = 0.005), in groups 2 and 3 – by 2.0 and 3.4 respectively (p < 0.001). In groups 1 and 2, in cases of DMP relapse, the level of TNFα was significantly higher than in case of no relapse, which was especially characteristic of patients with initial NPDR and related to early relapses. There was no association of TNFα level with DMP relapses in patients with PDR (group 3) – cytokine level was significantly increased, although this was more true for patients with PDR (the median was 49.2 pg/ml in case of relapse and 57.4 pg/ml in case of its absence; p = 0.062). Also, there was a higher level of TNFα in patients with early and persistent relapses (p < 0.05).

Conclusion. The study revealed a relationship between the elevation of TNFα baseline blood level and the formation of early and persistent relapses after surgical treatment of DMP.

Keywords: diabetic maculopathy, type 2 diabetes mellitus, surgical treatment, TNFα.

 
REFERENCES

  1. Pasyechnikova NV, Suk SA, Kuznecova TA, Parkhomenko OG. [Diabetic maculopathy. Modern aspects of pathogenesis, clinic, diagnosis, treatment]. Kyiv; 2010. Russian.
  2. Diep TM, Tsui I. Risk factors associated with diabetic macular edema. Diabetes Res Clin Practice. 2013 Jun;100(3):298–305.
  3. Kamoi K. Identifying risk factors for clinically significant diabetic macula edema in patients with type 2 diabetes mellitus. Curr Diabetes Rev. 2013 May;9(3):209–17.
  4. Jenkins AJ, Joglekar MV, Hardikar AA, et al. Biomarkers in Diabetic Retinopathy. Rev Diabet Stud. 2015 Spring-Summer;12(1–2):159–95.
  5. Eshaq RS, Aldalati AMZ, Alexander JS, Harris NR. Diabetic retinopathy: Breaking the barrier. Pathophysiology. 2017;24(4):229–41. https://doi.org/10.1016/j.pathophys.2017.07.001
  6. Liu C, Feng X, Li Q, et al. Adiponectin, TNF-α and inflammatory cytokines and risk of type 2 diabetes: A systematic review and meta-analysis. Cytokine. 2016 Oct;86:100–9. https:// doi.org/10.1016/j.cyto.2016.06.028
  7. IRS1 – Insulin receptor substrate 1 – Homo sapiens (Human) – IRS1 gene & protein». www. uniprot.org. Retrieved 2016-04-21.
  8. Takaguri A. [Elucidation of a new mechanism of onset of insulin resistance: effects of statins and tumor necrosis factor-α on insulin signal transduction]. Yakugaku Zasshi. 2018;138(11): 1329–34. https://doi.org/10.1248/yakushi.18-00116. Japanese.
  9. Copps KD, White MF. Regulation of insulin sensitivity by serine/threonine phosphorylation of insulin receptor substrate proteins IRS1 and IRS2. Diabetologia. 2012;55(10):2565–82. https://doi.org/10.1007/s00125-012-2644-8
  10. Балашевич ЛИ, Измайлов АС. Диабетическая офтальмопатия. СПб.: Человек; 2012. Balashevich LI, Izmaylov AS. [Diabetic ophthalmopathy]. St. Petersburg; 2012. Russian.
  11. Xiao K, Dong YC, Xiao XG, et al. Effect of Pars Plana Vitrectomy With or Without Cataract Surgery in Patients with Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther. 2019;10(5):1859–68. https://doi.org/10.1007/s13300-019-0672-9
  12. Panchenko IuO, Mogilevskyy SIu. [Effects of vitreoretinal operations on clinical picture of diabetic maculopathy in patients with type 2 diabetes mellitus]. Archive Of Ukrainian Ophthalmology. 2019;7(1):68–73. Ukrainian. https://doi.org/10.22141/2309-8147.7.1.2019.163011
  13. Panchenko Yu. Possibilities and effectiveness of cataract phacoemulsifcation, closed subtotal vitrectomy and panretinal laser coagulation in diabetic maculopathy treatment in patients with type 2 diabetes. East European Science Journal. 2019;7 (47 part 2):50–6.
  14. Mogilevskyy SYu, Panchenko IuO, Ziablitsev SV. [Predicting the risk of diabetic retinopathy associated macular edema in patients with type 2 diabetes mellitus]. J.ophthalmol. 2019;3:3–8. Ukrainian. http://doi.org/10.31288/oftalmolzh2019338
  15. Loukovaara S, Piippo N., Kinnunen K., et al. NLRP3 inflammasome activation is associated with proliferative diabetic retinopathy. Acta Ophthalmol. 2017 Dec;95(8):803–8. https:// doi.org/10.1111/aos.13427
  16. Rykov SA, Mogilevskiy SY, Parkhomenko OG, Suk SA. [Improved Algorithm of Analysis of Optical Coherence Tomography Images of Macula in Diabetic Macular Edema]. Archive of Ukrainian Ophthalmology. 2015;3(1(3)):40–7. Russian.
  17. Raczyńska D, Lisowska KA, Pietruczuk K, et al. The Level of Cytokines in the Vitreous Body of Severe Proliferative Diabetic Retinopathy Patients Undergoing Posterior Vitrectomy. Curr Pharm Des. 2018;24(27):3276–81. https://doi.org/10.2174/1381612824666180926110704
  18. Boss JD, Singh PK, Pandya HK, et al. Assessment of Neurotrophins and Inflammatory Mediators in Vitreous of Patients With Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 2017 Oct 1;58(12):5594–603. https://doi.org/10.1167/iovs.17-21973
  19. Kovacs K, Marra KV, Yu G, et al. Angiogenic and Inflammatory Vitreous Biomarkers Associated With Increasing Levels of Retinal Ischemia. Invest Ophthalmol Vis Sci. 2015 Oct; 56(11):6523–30. https://doi.org/10.1167/iovs.15-16793

Received: 02 Sep. 2019

Published: December 2019