Microcirculatory Changes And Cytokine Expression In The Aqueous Humor Of Diabetic Macular Edema Patients Treated With Anti VEGF Therapy

Purpose:To analyze the effect of cytokine expression in aqueous humor and macular microcirculation on the efficacy of anti-VEGF treatment of diabetic macular edema(diabetic Macularedema,DME)and the changes of observation indexes before and after treatment,and to explore the correlation between the three and the prediction of curative effect and the possible pathogenesis of DME.Methods:From January 2022 to February 2023,a total of 32 patients who were diagnosed with DME in the Department of Ophthalmology of Nanchang First Hospital and met the inclusion criteria,49 eyes were included in the study,and all affected eyes received standardized intravitreal injection of Conberxi General treatment(once a month,continuous treatment for 3 months).All patients underwent optical coherence tomography(OCT),OCTA,and aqueous humor cytokine detection before treatment.OCT was used to measure CMT,and OCTA was used to scan the macular area of the affected eye.The area of the foveal vascular zone(FAZ)in the superficial retinal capillary plexus(SCP),the retinal capillary plexus density(vessel density,VD),and the flow cytometric beadarray(CBA)method were used to detect aqueous humor samples The titers of IL-6,IL-8,IL-10 and VEGF in the blood.30±5 days after the third acupuncture treatment,recheck the above inspection contents,and divide them into two groups according to the decrease of CMT.The significant effect group is defined as the decrease of CMT≥50μm,with a total of 31 eyes.The decrease of CMT is less than 50μm or the thickness is increased than before.group,a total of 18eyes,compared the differences in the observation indicators between the two groups at the baseline,performed correlation analysis using spearman,and used the ROC curve to analyze the predictive effect of the observation indicators on the curative effect,and finally observed the expression of cytokines in the aqueous humor before and after treatment and Changes in microcirculation in the macular area.Result:There were no statistically significant differences in age,sex,eye type,intraocular pressure,duration of diabetes,visual acuity(Log MAR),SCP-FAZ,SCP-VD,and IL-6 between the two groups at baseline(t=-0.491 P=0.625,χ2=0.660P=0.550,χ2=0.848 P=0.390,t=-0.868 P=0.390,t=0.044 P=0.965,Z=-0.125 P=0.900,Z=-1.836 P=0.066,t=0.517 P=0.068,Z=-1.597 P=0.110).The decrease of CMT in the significant curative effect group was greater than that in the non-significant curative effect group(Z=-5.787 P<0.001).Spearman analysis results:There is a positive correlation between VEGF factor and the decrease of CMT(R=0.586 P<0.001).There was a no correlation between IL-6 and the decrease of CMT(r_s=0.105 P=0.474).There was a significant negative correlation between IL-8 and the decrease of CMT(r_s=0.692 P<0.001).There was a positive correlation between IL-10 and the decrease of CMT(r_s=0.370 P=0.009).The area of FAZ in superficial retina was no correlated with the decrease of CMT(r_s=-1.88 P=0.196).There was no correlation between VD and the decrease of CMT in the superficial retina(r_s=0.113 P=0.440).VEGF,IL-6,IL-8,IL-10 have no correlation with SCP-FAZ area and SCP-VD(r_s=0.099 P=0.498,r_s=0.156,P=0.258,r_s=0.055 P=0.706,r_s=-0.054 P=0.711).VEGF,IL-6,IL-8,IL-10 have no correlation with SCP-VD(r_s=-0.176 P=0.227,r_s=-0.022 P=0.883,r_s=-0.050 P=0.732,r_s=-0.001P=0.995).ROC curve result:The IL-8 AUC is 0.821 and the standard is 0.060,P=0.000,95%CI(0.704,0.930).The IL-10 AUC is 0.677and the standard is 0.077,P=0.04,95%CI(0.526,0.829).The VEGF AUC is 0.811and the standard is 0.061,P=0.000,95%CI(0.692,0.930).Changes of cytokines in aqueous humor and macular microcirculation before and after treatment:the levels of VEGF,IL-6,IL-8 and IL-10 decreased significantly after treatment,and the difference was statistically significant(Z=-6.093 P<0.01,Z=-3.890 P<0.01,Z=-3.646 P<0.01,Z=2.728 P=0.006),There was no significant change in SCP-FAZ and SCP-VD before and after treatment(Z=-1.317 P=0.188,Z=-1.593 P=0.118).Conclusion(Under the current treatment plan):There is a correlation between VEGF,IL-8,IL-10 and the efficacy of anti-VEGF therapy in patients with DME,and IL-8 can be used to predict the efficacy of anti-VEGF therapy.There may be no correlation between the changes of macular microcirculation and the efficacy of anti-VEGF treatment.The expression levels of VEGF,IL-6,IL-8 and IL-10 in DME patients decreased significantly after anti-VEGF treatment,and there was no difference in SCP-FAZ and SCP-VD compared with those before treatment.Anti-VEGF treatment had no effect on superficial retinal microcirculation.There may be no correlation between the expression of cytokines in aqueous humor and the changes of macular microcirculation.