The correlation between cytokine levels in the aqueous humor and the prognostic value of anti-vascular endothelial growth factor therapy for treating macular edema resulting from retinal vein occlusion

Dynamic Complement Protein Changes in Aqueous Humor and Plasma of Patients With Retinal Vein Occlusion During Ranibizumab Treatment

Purpose

To assess dynamic changes of complement protein in aqueous humor (AH) and plasma of retinal vein occlusion (RVO) patients during ranibizumab treatment, and to explore the differential expression of complement proteins in branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).

Patients and Methods

This prospective, consecutive case series study collected AH and plasma samples from 27 RVO patients at baseline, 1 and 2 months after ranibizumab treatment, including 19 BRVO and 8 CRVO patients. The concentrations of 13 complement proteins and vascular endothelial growth factor A (VEGF-A) were measured using Luminex® × MAP® technology.

Results

During ranibizumab treatment, a reduction in the levels of C1q (p < 0.001), C2 (p = 0.030), C4 (p = 0.001), C4b (p = 0.026), C3b/iC3b (p < 0.001), C5 (p = 0.007), C5a (p = 0.005), CFD (p = 0.022), CFH (p < 0.001), and CFI (p < 0.001) in AH was observed. No significant changes were observed in the plasma levels of all measured factors. At baseline, CRVO had higher levels of C4 (p = 0.003), C4b (p < 0.001), C3b/iC3b (p < 0.001), C5 (p = 0.020), C5a (p = 0.007), CFD (p = 0.002), CFH (p < 0.001), and CFI (p < 0.001) in AH compared to BRVO.

Conclusion

Ranibizumab treatment reduced the intraocular but not circulating activation of classical and alternative complement pathways in RVO patients. Differences in intraocular complement proteins were observed between BRVO and CRVO patients, which may reflect different pathogenesis.

Baicalin alleviates the injury of human retinal pigment epithelium cells and improves branch retinal vein occlusion in rats by inhibiting the HIF-1α/VEGFA axis

BACKGROUND

At present, relevant studies have found that baicalin can improve macular edema (ME) caused by glaucoma, but the effect on branch retinal vein occlusion (BRVO) is still unclear.

METHODS

The CoCl2-stimulated ARPE-19 cells were treated with different concentrations of baicalin and detected cell viability, apoptosis and oxidative stress. Next, the hypoxia-inducible factor-1α (HIF-1α) overexpression vector or siRNA were transfected into CoCl2-stimulated ARPE-19 cells, and the cell changes were detected. We searched the potential binding proteins of HIF-1α through the online database, and screened vascular endothelial growth factor A (VEGFA) as the research object. The CoCl2-stimulated ARPE-19 cells were treated with baicalin alone, or transfected with HIF-1α overexpression vector, or transfected with HIF-1α overexpression vector and VEGFA siRNA, and the cell changes were detected. Finally, we verified the therapeutic effect of baicalin on BRVO rats in vivo.

RESULTS

Baicalin inhibited CoCl2-induced apoptosis, inflammation and oxidative stress in ARPE-19 cells, and baicalin inhibited HIF-1α protein expression. In CoCl2-induced hypoxia cells, HIF-1α aggravated apoptosis, inflammation and oxidative stress, while HIF-1α silencing alleviated cell damage. Mechanism study showed that in baicalin-treated CoCl2-induced cells, VEGFA protein expression decreased and cell damage was improved, but this protective effect was counteracted by HIF-1α, and VEGFA silencing again inhibited apoptosis, inflammation and oxidative stress. Baicalin inhibited HIF-1α and VEGFA protein expression in the retinal tissue of BRVO rats, reduced injury, and promoted the recovery of ganglion cell layer.

CONCLUSIONS

Baicalin alleviated ARPE-19 cell injury and improved BRVO in rats by inhibiting HIF-1α/VEGFA axis in vivo and in vitro.

Intraocular complement activation is independent of systemic complement activation and is related to macular vascular remodelling in retinal vein occlusion

BACKGROUND

Retinal vein occlusion (RVO) is a major cause of vision loss. The pathogenesis remains poorly defined although inflammation is known to play a critical role. In this study, we investigated the levels of complement proteins in the aqueous humour and plasma of RVO participants and the relationship between complement levels and retinal pathologies.

METHODS

The plasma and aqueous humour were collected from 20 treatment-naive RVO and 20 cataract patients. Retinal lesions were examined by fundus stereoscopy and optical coherence tomography angiography. The levels of C1q, C2, C4, C4b, C3, C3b/iC3b, C5, C5a, CFB, CFD, CFI, CFH, and MBL in the plasma and aqueous humour were measured using the Luminex® x MAP® multiplex assay.

RESULTS

RVO patients had significantly higher levels of C4, C4b, C3b/iC3b, CFB, and CFH in the plasma and aqueous humour compared to controls. The aqueous levels of C1q, C2, C5, C5a, and MBL were also significantly higher in RVO patients than in controls. CRVO patients had higher intraocular levels of C1q, C4, C5, CFI, CFH, and MBL than BRVO patients. C5a was below the detectable limit in the plasma in 18 cataracts and 16 RVO participants. The intraocular levels of C5a positively correlated with C1q, C2, C4, C3, C5, CFB, CFH, and MBL. The intraocular levels of CFD, CFI and MBL positively correlated with CRT, and the levels of C2, C3, C5, CFB, and MBL negatively correlated with the size of the foveal avascular zone. The plasma levels of C4b, C3b/iC3b, and CFD positively correlated with their counterparts in the aqueous humour in cataracts but not in RVO patients. The ratios of aqueous humour/plasma of C1q, C4, C4b, C3b/iC3b, C5, CFB, CFD, CFI, and CFH in the RVO patients were significantly higher than those in the cataract patients.

DISCUSSION AND CONCLUSIONS

The intraocular complement activation in RVO is mediated by the classical and the alternative pathways and is largely independent of systemic complement activation. Intraocular complement activation may be related to retinal oedema and vascular remodeling in RVO patients.

Evaluating the Efficacy of Conbercept and Dexamethasone Implants Sequentially in the Treatment of Refractory Macular Edema Secondary to Central Retinal Vein Occlusion (CRVO): A One-Year Follow-Up Study

Purpose

The objective of this research was to assess the effectiveness and safety of using Conbercept injection and dexamethasone implant (DEX I) in sequence for treating refractory macular edema (ME) caused by central retinal vein occlusion (CRVO) in patients.

Methods

A study was conducted on 34 patients with persistent macular edema caused by central retinal vein occlusion, reviewing their medical history and interventions performed. Sequential implantation of DEX I was performed 1 week after the Conbercept injection. OCTA images were used to measure central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and pre- and post-treatment vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), with a 1-year follow-up period.

Results

At the 12-month follow-up, participants demonstrated notable improvements in central retinal thickness and intraocular pressure (p < 0.05). Throughout the monitoring period, no significant differences were found in BCVA improvement or vessel density reduction (p > 0.05). Two patients required topical treatment to lower their intraocular pressure during the study period.

Conclusion

In conclusion, patients experiencing persistent ME due to secondary CRVO may benefit from transitioning to a treatment regimen involving Conbercept and DEX I, potentially resulting in a reduction in CRT. However, no significant improvement was observed in BCVA or deep and superficial capillary plexus vessel density.

Integrated Assessment of OCT, Multimodal Imaging, and Cytokine Markers for Predicting Treatment Responses in Retinal Vein Occlusion Associated Macular Edema: A Comparative Review of Anti-VEGF and Steroid Therapies

Retinal vein occlusion (RVO) is a significant cause of vision loss, characterized by the occlusion of retinal veins, leading to conditions such as central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Macular edema (ME), a prevalent consequence of RVO, is the primary cause of vision impairment in affected patients. Anti-VEGF agents have become the standard treatment, showing efficacy in improving visual acuity (VA) and reducing ME. However, a subset of patients exhibit a suboptimal response to anti-VEGF therapy, necessitating alternative treatments. Corticosteroids, which address inflammatory pathways implicated in ME, have shown promise, particularly in cases resistant to anti-VEGF. This review aims to identify biomarkers that predict treatment response to corticosteroids in RVO-associated ME, utilizing multimodal imaging and cytokine assessments. Baseline imaging, including SD-OCT and OCT-A, is essential for evaluating biomarkers like hyperreflective foci (HRF), serous retinal detachment (SRF), and central retinal thickness (CRT). Elevated cytokine levels, such as IL-6 and MCP-1, correlate with ME severity and poor anti-VEGF response. Early identification of these biomarkers can guide timely transitions to corticosteroid therapy, potentially enhancing treatment outcomes. The practical conclusion of this review is that integrating biomarker assessment into clinical practice enables personalized treatment decisions, allowing for earlier and more effective management of RVO-associated ME by transitioning patients to corticosteroid therapy when anti-VEGF agents are insufficient. Advanced diagnostics and machine learning may further refine personalized treatment strategies, improving the management of RVO-associated ME.

The role of retinal glial cells and related factors in macular edema

Macular edema (ME) has emerged as a leading cause of visual impairment, representing a critical clinical manifestation and complication associated with many eye diseases. In the occurrence and development of ME, retinal glial cells like Müller cells and microglial cells play vital roles. Moreover, growth factor and cytokines associated with them, such as vascular endothelial growth factor (VEGF), pigment epithelium-derived factor (PEDF), hypoxia-inducible factor-1α (HIF-1α), angiopoietin-like protein 4 (ANGPTL4), interleukin-6(IL-6), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), prostaglandin, etc., also take part in the pathogenesis of ME. Changes in these cytokines can lead to retinal angiogenesis, increased vascular permeability, blood-retinal barrier (BRB) breakdown, and fluid leakage, further causing ME to occur or deteriorate. Research on the role of retinal glial cells and related cytokines in ME will provide new therapeutic directions and effective remedies. This article is a literature review on the role of Müller cells, microglial cells and related factors in ME pathogenesis.

Biochemical and microstructural determinants of the development of serous retinal detachment secondary to retinal vein occlusion

Purpose

To study the alteration of cytokine factors in aqueous humor and retinal microstructure in the formation of serous retinal detachment (SRD) secondary to retinal vein occlusion.

Methods

The subjects were 39 patients with RVO, of whom 31 patients had SRD (RVO-SRD). Spectral Domain Optical Coherence Tomography (SD-OCT) was used to measure the completeness of photoreceptor inner segment/outer segment (IS/OS) and the external limiting membrane (ELM) as well as the structure of RVO-SRD, including the height and shape of SRD. The aqueous humor was collected before intravitreal injection of Ranibizumab. The concentrations of VEGF, MCP-1, IL-8, IL-6, b-FGF and TNF-α in the aqueous humor were measured. All patients participated in the 6-month follow-up examinations, which included visual acuity, intraocular pressure, ophthalmologic examination, and SD-OCT. The time of recurrence of RVO-SRD was recorded.

Results

The formation of SRD was associated with the area of congested vein, disrupted IS/OS, ELM layers and high VEGF, MCP-1, IL-8, IL-6 levels. However, the height and shape of SRD were not relevant to any inflammatory factors. Moreover, high levels of MCP-1, IL-8 and IL-6 were found in large areas of congested veins. High levels of MCP-1 and IL-6 were observed in the patients with incomplete IS/OS and ELM. The recurrence of SRD was related to the high MCP-1 level.

Conclusion

High concentrations of cytokine factors in aqueous humor could induce vascular leakage, exacerbate the extent of macular edema, disrupt the structure of ELM and IS/OS, and develop SRD in RVO.

Increased intraocular inflammation in retinal vein occlusion is independent of circulating immune mediators and is involved in retinal oedema

We aim to understand the link between systemic and intraocular levels of inflammatory mediators in treatment-naïve retinal vein occlusion (RVO) patients, and the relationship between inflammatory mediators and retinal pathologies. Twenty inflammatory mediators were measured in this study, including IL-17E, Flt-3 L, IL-3, IL-8, IL-33, MIP-3β, MIP-1α, GRO β, PD-L1, CD40L, IFN-β, G-CSF, Granzyme B, TRAIL, EGF, PDGF-AA, PDGF-AB/BB, TGF-α, VEGF, and FGFβ. RVO patients had significantly higher levels of Flt-3 L, IL-8, MIP-3β, GROβ, and VEGF, but lower levels of EGF in the aqueous humor than cataract controls. The levels of Flt-3 L, IL-3, IL-33, MIP-1α, PD-L1, CD40 L, G-CSF, TRAIL, PDGF-AB/BB, TGF-α, and VEGF were significantly higher in CRVO than in BRVO. KEGG pathway enrichment revealed that these mediators affected the PI3K-Akt, Ras, MAPK, and Jak/STAT signaling pathways. Protein-Protein Interaction (PPI) analysis showed that VEGF is the upstream cytokine that influences IL-8, G-CSF, and IL-33 in RVO. In the plasma, the level of GROβ was lower in RVO than in controls and no alterations were observed in other mediators. Retinal thickness [including central retinal thickness (CRT) and inner limiting membrane to inner plexiform layer (ILM-IPL)] positively correlated with the intraocular levels of Flt-3 L, IL-33, GROβ, PD-L1, G-CSF, and TGF-α. The size of the foveal avascular zone positively correlated with systemic factors, including the plasma levels of IL-17E, IL-33, INF-β, GROβ, Granzyme B, and FGFβ and circulating high/low-density lipids and total cholesterols. Our results suggest that intraocular inflammation in RVO is driven primarily by local factors but not circulating immune mediators. Intraocular inflammation may promote macular oedema through the PI3K-Akt, Ras, MAPK, and Jak/STAT signaling pathways in RVO. Systemic factors, including cytokines and lipid levels may be involved in retinal microvascular remodeling.

Characteristics of Hematologic Parameters in Young Patients with Retinal Vein Occlusion

INTRODUCTION

The aim of this study was to investigate the characteristics of hematologic parameters in young patients with retinal vein occlusion (RVO).

METHODS

All participants underwent routine ocular examinations and blood sample tests. Hematologic parameters obtained from a complete blood count, as well as the calculation of specific inflammatory indices, were compared between young patients with RVO and the control subjects. Correlations between hematologic inflammatory biomarkers and aqueous humor inflammatory cytokines were also investigated.

RESULTS

A total of 64 patients with RVO and 64 age- and gender-matched control subjects were included in this study. The white blood cell count, neutrophil cell count, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) in young patients with RVO were significantly higher than in the controls (all p < 0.05). Compared to patients with nonischemic RVO, patients with ischemic RVO had higher NLR, SII, and SIRI values (p = 0.032, p = 0.035, and p = 0.039, respectively). The areas under the receiver operator characteristic curve were 0.725, 0.651, 0.649, and 0.634 for the MPV, NLR, SII, and SIRI, respectively. In addition, a higher NLR was related to higher levels of interleukin 6 (IL-6; p = 0.046, R = 0.463), and a higher SII was related to higher levels of IL-6 (p = 0.034, R = 0.488) and vascular endothelial growth factor (p = 0.020, R = 0.528).

CONCLUSION

The NLR, SII, and SIRI were significantly elevated in young patients with RVO, especially in young patients with ischemic RVO. NLR and SII were positively correlated with IL-6 levels in aqueous humor, which indicated that systemic inflammation plays an important role in the onset of RVO in young patients.

Retinal Macrophage-Like Cells as a Biomarker of Inflammation in Retinal Vein Occlusions

Aim: To study the macrophage-like cells (MLC) of the inner retinal surface in eyes with retinal vein occlusions (RVO) and the association of MLC with clinical characteristics of RVO. Methods: In this retrospective cross-sectional study, the medical records and multimodal imaging data of treatment-naïve patients with unilateral RVO and no abnormalities of vitreoretinal interface electronic were reviewed and analyzed. To visualize MLC, structural projections of optical coherence tomography (OCT) angiography scans within a slab between two inner limiting membrane segmentation lines (with 0 and −9 µm offset) were evaluated. The density of MLC was calculated and compared between affected and fellow eyes of each patient with regards to OCT and clinical characteristics of RVO. Results: Thirty-six eyes (twenty-eight branch RVO and eight central RVO) of 36 patients (21 males and 15 females, mean age 48.9 ± 9.8 years) were included. The density of MLC in affected eye was statistically significantly higher than that of the fellow eye, 8.5 ± 5.5 and 4.0 ± 3.6 cells/mm2, respectively (p < 0.001). The MLC density in the affected eye had a statistically significantly correlation with that of the fellow eye (r = 0.76, p = 0.0001), but with none of the OCT and clinical characteristics of the affected eye apart from the presence of subfoveal fluid. Eyes with subfoveal fluid had a statistically significantly higher mean number of MLC than that of eyes without subfoveal fluid, 12.6 ± 6.3 and 6.9 ± 4.0 cells/mm2, respectively (p = 0.009). Conclusion: The number of MLC on the inner retinal surface increases in RVO eyes which may reflect the activation of inflammatory pathways.

Tear Proteome Revealed Association of S100A Family Proteins and Mesothelin with Thrombosis in Elderly Patients with Retinal Vein Occlusion

Tear samples collected from patients with central retinal vein occlusion (CRVO; n = 28) and healthy volunteers (n = 29) were analyzed using a proteomic label-free absolute quantitative approach. A large proportion (458 proteins with a frequency > 0.6) of tear proteomes was found to be shared between the study groups. Comparative proteomic analysis revealed 29 proteins (p < 0.05) significantly differed between CRVO patients and the control group. Among them, S100A6 (log (2) FC = 1.11, p < 0.001), S100A8 (log (2) FC = 2.45, p < 0.001), S100A9 (log2 (FC) = 2.08, p < 0.001), and mesothelin ((log2 (FC) = 0.82, p < 0.001) were the most abundantly represented upregulated proteins, and β2-microglobulin was the most downregulated protein (log2 (FC) = −2.13, p < 0.001). The selected up- and downregulated proteins were gathered to customize a map of CRVO-related critical protein interactions with quantitative properties. The customized map (FDR < 0.01) revealed inflammation, impairment of retinal hemostasis, and immune response as the main set of processes associated with CRVO ischemic condition. The semantic analysis displayed the prevalence of core biological processes covering dysregulation of mitochondrial organization and utilization of improperly or topologically incorrect folded proteins as a consequence of oxidative stress, and escalating of the ischemic condition caused by the local retinal hemostasis dysregulation. The most significantly different proteins (S100A6, S100A8, S100A9, MSLN, and β2-microglobulin) were applied for the ROC analysis, and their AUC varied from 0.772 to 0.952, suggesting probable association with the CRVO.

The Changes of Irisin and Inflammatory Cytokines in the Age-Related Macular Degeneration and Retinal Vein Occlusion

Purpose

Age-related macular degeneration (AMD) and retinal vein occlusion (RVO) are irreversible chorioretinal diseases, which might induce severe damage in visual function. The metabolic factor and inflammatory factors might play important roles in the pathogenesis of AMD and RVO. The levels of irisin and 14 cytokines were analyzed in aqueous humor of AMD and RVO eyes to evaluate the roles of irisin and inflammatory factors.

Methods

We collected aqueous humor samples from patients with AMD (n = 27), RVO (n = 30), and cataract (as control, n = 23) eyes. Samples were assayed using ELISA kit for irisin and a multiplex immunoassay kit for 14 cytokines. The macular thickness (MT) was measured with OCT in all included eyes.

Results

MT in the RVO group is significantly higher than that in the AMD or control group. Irisin levels in the aqueous samples of AMD and RVO eyes were both significantly lower than that in the control. Furthermore, a positive correlation was found between irisin and MT in the RVO. Compared with the controls, AMD eyes had significantly higher levels of BDNF, VEGF-A, VEGF-R1, VEGF-R2, IL-10, TNF-α, VCAM-1, IP-10, and MCP-1. Similarly, RVO eyes had significantly higher levels of BDNF, VEGF-A, VEGF-R1, VEGF-R2, IL-6, IL-8, IL-10, TNF-α, ICAM-1, VCAM-1, IP-10, and MCP-1. However, there was no significant difference between the levels of PDGF-BB or TNF-β in these three groups. A negative correlation was found between VEGF-A and MT in AMD, as well as in control. Furthermore, a positive correlation was found between IL-6 and MT in the 80 included eyes, as well as in RVO. A positive correlation was found between ICAM-1 and MT in the 80 included eyes, as well as in RVO.

Conclusions

The metabolic factor, irisin levels in the aqueous humor are decreased in AMD and RVO eyes and show a positive correlation between irisin and MT in RVO eyes, prompting researchers to explore the relationship between irisin and macular edema. We also identified the higher expression of vascular growth factors (VEGF-A, VEGF-R1, and PDGF-BB), inflammatory cytokines (IL-6, IL-8, IL-10, and TNF-α), and chemokines (ICAM-1, VCAM-1, IP-10, and MCP-1) in AMD and RVO eyes.

Metabolite Changes in the Aqueous Humor of Patients With Retinal Vein Occlusion Macular Edema: A Metabolomics Analysis

Macular edema (ME) is the main cause of visual impairment in patients with retinal vein occlusion (RVO). The degree of ME affects the prognosis of RVO patients, while it lacks objective laboratory biomarkers. We aimed to compare aqueous humor samples from 28 patients with retinal vein occlusion macular edema (RVO-ME) to 27 age- and sex-matched controls by ultra-high-performance liquid chromatography equipped with quadrupole time-of-flight mass spectrometry, so as to identify the key biomarkers and to increase the understanding of the mechanism of RVO-ME at the molecular level. Through univariate and multivariate statistical analyses, we identified 60 metabolites between RVO-ME patients and controls and 40 differential metabolites in mild RVO-ME [300 μm ≤ central retinal thickness (CRT) < 400 μm] patients compared with severe RVO-ME (CRT ≥ 400 μm). Pathway enrichment analysis showed that valine, leucine, and isoleucine biosynthesis; ascorbate and aldarate metabolism; and pantothenate and coenzyme A biosynthesis were significantly altered in RVO-ME in comparison with controls. Compared with mild RVO-ME, degradation and biosynthesis of valine, leucine, and isoleucine; histidine metabolism; beta-alanine metabolism; and pantothenate and coenzyme A biosynthesis were significantly changed in severe RVO-ME. Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that adenosine, threonic acid, pyruvic acid, and pyro-L-glutaminyl-l-glutamine could differentiate RVO-ME from controls with an area under the curve (AUC) of >0.813. Urocanic acid, diethanolamine, 8-butanoylneosolaniol, niacinamide, paraldehyde, phytosphingosine, 4-aminobutyraldehyde, dihydrolipoate, and 1-(beta-D-ribofuranosyl)-1,4-dihydronicotinamide had an AUC of >0.848 for distinguishing mild RVO-ME from severe RVO-ME. Our study expanded the understanding of metabolomic changes in RVO-ME, which could help us to have a good understanding of the pathogenesis of RVO-ME.