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Aqueous humour cytokine changes during a loading phase of intravitreal ranibizumab or dexamethasone implant in diabetic macular oedema
Author(s) -
Podkowinski Dominika,
OrlowskiWimmer Eva,
Zlabinger Gerhard,
Pollreisz Andreas,
MurschEdlmayr AnnaSophie,
Mariacher Siegfried,
Ring Michael,
Bolz Matthias
Publication year - 2020
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14297
Subject(s) - ranibizumab , medicine , dexamethasone , ophthalmology , aqueous humour , implant , cytokine , aqueous humor , diabetic retinopathy , diabetes mellitus , surgery , bevacizumab , endocrinology , chemotherapy
Purpose To determine the effect of intravitreal ranibizumab and a dexamethasone implant on aqueous humour cytokine, protein and enzyme levels and to correlate findings to morphologic and functional changes. Methods In a prospective, randomized, controlled, double‐blind study, patients with clinically significant diabetic macular oedema ( CSME ) were randomly allocated to receive either monthly intravitreal injections of ranibizumab (Lucentis, Novartis Pharma) or a single dexamethasone implant (Ozurdex, Pharm‐Allergan) at baseline ( BL ). Aqueous humour samples were collected at BL and weeks 2, 8 and 20. Results The study included 18 eyes of 18 patients. In the dexamethasone implant group, soluble intercellular adhesion molecule 1 ( sICAM ‐1) (weeks 2 and 8), CXCL 9/monokine induced by gamma interferon ( MIG ) (weeks 2 and 8), soluble vascular cell adhesion protein 1 ( sVCAM ‐1) (weeks 2 and 8) and monocyte chemo‐attractant protein 1 ( MCP ‐1) (week 2) levels were significantly decreased compared with baseline. In the ranibizumab group, placental growth factor ( PIGF ) (week 2) and vascular endothelial growth factor ( VEGF ) (week 2 and 8) levels were significantly decreased compared with baseline. No significant changes in central retinal thickness ( CRT ) or Early Treatment Diabetic Retinopathy Study ( ETDRS ) best corrected visual acuity ( BCVA ) were observed in the Ozurdex group at any time‐points. ETDRS scores significantly increased at week 20 (84.88 ± 8.88 letters) compared with baseline (74.78 ± 14.85 letters), and the CRT decreased significantly at week 4 (381.00 ± 114.64 μm) compared with baseline (440 ± 144 μm) in the Lucentis group. Conclusion The dexamethasone implant affected the aqueous cytokines and proteins MCP ‐1, sICAM ‐1, sVCAM ‐1 and MIG , whereas ranibizumab treatments reduced VEGF and PIGF levels. Morphological changes may diverge from cytokine changes. Results may indicate a rationale for a combination therapy for CSME using both agents, the dexamethasone implant and repeatedly administered ranibizumab injections.