| Objective:Based on optical coherence tomography(OCT),diabetic macular edema(DME)was classified to observe the difference of inflammatory factors in aqueous humor of different types of DME and the changes of inflammatory factors in aqueous humor after intravitreal injection of Conbercept for the first time.Methods:A total of 69 patients(69 eyes)with DME who met the inclusion criteria in the Department of Ophthalmology of the second affiliated Hospital from April 2022 to January 2023 were collected as the experimental group.At the same time,15 patients(15 eyes)who denied the history of diabetes who underwent cataract extraction were selected as the control group.Based on the morphology of OCT,the patients in the experimental group were divided into three groups: diffuse retinal thickening(DRT)group 23 cases(33.33%),Cystoid macular edema(CME)group 21 cases(30.43%),serous retinal detachment(SRD)group 25 cases(36.23%).All the subjects in the experimental group received intraocular injection for the first time.Before treatment,all patients were examined by ophthalmology,and the relevant data were recorded,such as best corrected visual acuity,intraocular pressure,central retinal thickness(CRT),slit lamp examination and so on.The patients in the experimental group were given intravitreal injection of Conbercept injection according to 3+RPN.The aqueous humor 0.1ml was extracted before the first and second injection,while the same amount of aqueous humor was extracted in the control group before the start of the related operation.Detection of vascular endothelial growth factor(VEGF),interleukin-6(IL-6)and intercellular adhesion molecule-1(ICAM-1)in aqueous humor by enzyme-linked immunosorbent assay(ELISA).To analyze the difference and correlation of VEGF,IL-6 and ICAM-1 in aqueous humor of patients with different types of DME,and the changes of VEGF and inflammatory factors in aqueous humor after intravitreal injection of Conbercept and their relationship with CRT changes.The central retinal thickness(CRT)was measured by OCT before the first and second intravitreous injection of Conbercept,respectively,and the improvement of macular edema was evaluated by observing the changes of CRT.Results:1.Comparison between the experimental group and the control group(1)There was no significant difference in age,sex,ocular distinction,intraocular pressure and history of hypertension between the two groups(P>0.05).(2)The levels of VEGF,IL-6 and ICAM-1 in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).2.Comparison between groups in experimental group(1)There was no significant difference in the course of diabetes,glycosylated hemoglobin,baseline best corrected visual acuity and history of hypertension among the three experimental groups(P>0.05).There were significant differences in baseline CRT among the three groups(P < 0.05).(2)There was no significant difference in the baseline level of VEGF among the three groups(P>0.05),but there was significant difference in the baseline levels of IL-6 and ICAM-1 among the three groups(P < 0.05).The level of IL-6 in SRD and CME was higher than that in DRT;ICAM-1of the three kinds of DME,SRD and DRT were higher than CME,and the difference was statistically significant(P < 0.05).(3)There was no correlation between VEGF,IL-6 and ICAM-1 and baseline CRT in three groups of DME(P >0.05).3.Comparison of patients in the experimental group after treatment with that before treatment.(1)The CRT of the three groups after DME treatment was lower than that before treatment,and the decrease of CRT in DRT and SRD was greater than that in CME,and the difference was statistically significant(P < 0.05).(2)The level of VEGF decreased in all three groups,and the difference was statistically significant(P < 0.05),but the change of VEGF in the three groups had no significant difference.(3)The concentration of IL-6 in DRT and CME groups after treatment was significantly lower than that before treatment(P < 0.05),but there was no significant change in IL-6 level in SRD group.The concentration of ICAM-1 in DRT and SRD groups decreased significantly after treatment,and the difference was statistically significant(P < 0.05).There was no significant change in ICAM-1 in CME group.(4)There was a positive correlation between the change of ICAM-1 and the change of CRT in DRT and SRD groups(r = 0.478,P < 0.021),but there was no significant correlation between the changes of VEGF,IL-6 and CRT(P > 0.05).4.Comparison of drug injection times among three groups of patients with DMEThe patients with more than 3 injections in DRT and CME groups were significantly lower than those in SRD group(P < 0.05).Conclusion:1.A variety of inflammatory factors may be involved in the pathogenesis of DME.The exact inflammatory factors affected by different types of DME may be different.The change of IL-6 and ICAM1 levels in aqueous humor of DME may play an important role in predicting the efficacy of SRD.2.For DME patients with poor anti-VEGF effect or recurrent DME,it may be better to use anti-VEGF and anti-inflammatory therapy at the same time. |
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