The Effect And Cytokine Changes In Aqueous Humor Of Preoperative IVTA In Rhegmatogenous Retinal Detachment Associated With Choroidal Detachment

Objective:To observe the therapeutic effect of preoperative intravitreal triamcinolone acetonide(IVTA)in patients with rhegmatogenous retinal detachment associated with choroidal detachment(RRDCD),and determine the concentration of cytokines in aqueous humor before and after injection of triamcinolone acetonide(TA).To explore the role of various cytokines in the IVTA treatment of patients with RRDCD.Provide reference for clinical treatment of RRDCD.Methods:This study was conducted in the Second Norman Bethune Hospital of Jilin University,and 16 patients who were treated in the hospital from October 2021 to December 2022 were included in this study.The experimental group consisted of patients with primary RRDCD(7cases,7 eyes).IVTA was performed and vitrectomy was performed 3-8 days later.Aqueous humor was collected before IVTA and vitrectomy respectively.The control group was patients with primary rhegmatogenous retinal detachment who underwent vitrectomy(9 cases,9 eyes),and the aqueous humor was collected before operation.The patients’ baseline data(general conditions,chief complaints,present and past illness history)were collected and detailed eye examinations were performed.After IVTA,the patients in the experimental group were measured the intraocular pressure and observed the conditions of the anterior segment and fundus every day.The concentrations of 27 cytokines in aqueous humor were determined by Luminex technology.All data were analyzed using SPSS 26.0 software.Results:1.Baseline data: There were no statistically significant differences in admission vision,age,gender,disease course,history of hypertension and diabetes between the experimental group and the control group(P>0.05);The difference in intraocular pressure between the experimental group and the control group was statistically significant(P<0.05).For the risk factors of RRDCD,such as the existence of high myopia,macular hole,proliferative vitreoretinopathy(PVR)grade,and the range of retinal detachment,there were no statistically significant differences between the experimental group and the control group(P>0.05),while there was a statistically significant difference in lens state between the two groups(P<0.05).2.Comparison of aqueous humor cytokines between the experimental group(before IVTA)and the control group: The concentrations of 16 cytokines in the aqueous humor of the experimental group were significantly higher than those of the control group,and the differences were statistically significant(P< 0.05).These cytokines are as follows: interleukins(IL-2,IL-4,IL-8,IL-10,IL-12p40),chemokines(CXCL9,CXCL10,CCL4,CCL19),growth factors(FGF2,HGF),adhesion molecule(ICAM-1),colony-stimulating factor(G-CSF),interferons(IFN-α,IFN-γ)and tumor necrosis factor(TNF-α).The concentrations of IL-1β,IL-5,IL-6,CCL7,CCL11,CCL22,MCP-1,EGF,VEGF,VEGFR2 and PDGF-AA had no statistically significant differences between the two groups(P>0.05).3.The effect of IVTA treatment in the experimental group: The TA action time of the patients in the experimental group was 4.71±2.06 days(range 3-8 days),all patients were relieved of anterior uveitis after IVTA treatment,and the ultrasonography of the eyes showed that the choroidal detachment was basically reset.Compared with the admission intraocular pressure,the intraocular pressure of the patients on the day of vitrectomy was all higher and the difference was statistically significant(P<0.05).4.Changes of aqueous humor cytokines in the experimental group after IVTA treatment:After IVTA treatment in the experimental group,the concentrations of 4 cytokines increased,and the differences were statistically significant(P<0.05).These cytokines include:interleukins(IL-10,IL-12p40),chemokine(CXCL10)and interferon(IFN-γ).5.Correlation analysis results: The action time of TA was negatively correlated with the concentrations of CXCL10 and IL-10(P<0.05),and the action time of TA was not correlated with the concentrations of IL-12p40 and IFN-γ(P>0.05).There was no correlation between intraocular pressure and cytokine concentration in aqueous humor on the day of vitrectomy(P>0.05).The concentrations of IL-10 and CXCL10,IL-12p40 were positively correlated in the aqueous humor of patients in the experimental group before IVTA(P<0.05),and the concentrations of CXCL10 and IL-10,IL-12p40 were positively correlated in the aqueous humor after IVTA(P<0.05).Conclusions:1.Intravitreal triamcinolone acetonide in patients with rhegmatogenous retinal detachment associated with choroidal detachment can quickly reduce anterior uveitis,increase intraocular pressure,reset choroidal detachment.2.After intravitreal triamcinolone acetonide in patients with rhegmatogenous retinal detachment associated with choroidal detachment,the concentrations of IL-10,IL-12p40,CXCL10 and IFN-γ in aqueous humor increased,which may be the joint result of the antiinflammatory effect of triamcinolone acetonide and the continued development of PVR in disease states.3.For patients with rhegmatogenous retinal detachment associated with choroidal detachment,after the reduction of choroidal detachment is observed,early surgery is recommended to prevent persistent development of PVR.