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.

 
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Received: 02 Sep. 2019

Published: December 2019