The effect of intravitreal ranibizumab or Ozurdex® on the cytokine concetration in the anterior chamber in patients with diabetic macular edema

Session Details

Session Title: Free Paper Session 23: Vascular Diseases & Diabetic Retinopathy VI

Session Date/Time: Sunday 10/09/2017 | 08:00-09:30

Paper Time: 09:06

Venue: Room 120

First Author: : D.Podkowinski AUSTRIA

Co Author(s): :    E. Wimmer   A. Mursch-Edlmayr   G. Zlabinger   P. Waidhofer-Sollner   M. Ring   M. Bolz              

Abstract Details

Purpose:

The intravitreal injection of ranibizumab and dexamethasone are both effective treatments for diabetic macular edema widely used in clinical practice. The purpose of this study was to investigate the effects of dexamethasone implant and ranibizumab on the intraocular cytokines concentration and correlate the results with morphological and clinical findings.

Setting:

double blinded prospective study at the department of ophthalmology at the Kepler University Clinic, Linz. Cytokine analysis was performed at the Department of Immunology at the Medical University of Vienna.

Methods:

Patients with clinically significant macular edema were included at the study site. Patients were randomized to two groups: one group received an intravitreal dexamethasone implant (Ozurdex®, Pharm-Allergan) at baseline and the other group received monthly intravitreal injections with ranibizumab, five in total (Lucentis, Novartis Pharma). Anterior chamber fluid was extracted before treatment at baseline, at week 2, 8, and 20. Using the Muliplexassay following cytokines in the anterior chamber fluid were analyzed: Interleukin IL-6, IL-8, MCP-1, PDGF-AA, VEGF, ICAM-1, MIF, MIG, MMP-9, PAI-1, PLGF, TGF-beta, VCAM. At each visit an visual acuity in EDTRS, and an Spectralis OCT (Heidelberg, Germany) was performed. Fluorescein angiography (FA) was performed at baseline and week 12. Functional and morphological parameters were correlated for analysis between the two groups. Cytokine concentrations were compared between groups.

Results:

18 patients were included in the study. The mean age was similiar between the two groups. (Lucentis: 64.56±9; Ozurdex®: 66.89±9). The central retinal thickness at baseline was 471.33±177.47 in the Lucentis group and 460.00±122.60 in the Ozurdex® group (p>0.05). Statistically significant reduction in central retinal thickness was achieved in both groups at week 20. BCVA in EDTRS letters was significantly higher in both groups compared to baseline. Intraocular concentrations of the cytokines and correlations with morphological changes will be presented in detail. Fluorescein angiography analysis suggest differences in leakage changes between groups.

Conclusions:

Dexamethasone and ranibizumab are both effective treatment modalities for diabetic macular edema. However, according to the changes in cytokine levels following therapy there seem to be different modes of action. Morphologic changes in FA and OCT could be correlated to cytokine concentrations in the anterior chamber.

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