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Katić K, Katić J, Kumrić M, Božić J, Tandara L, Šupe Domić D, Bućan K. The Predictors of Early Treatment Effectiveness of Intravitreal Bevacizumab Application in Patients with Diabetic Macular Edema. Diagnostics (Basel) 2024; 14:992. [PMID: 38786290 PMCID: PMC11120272 DOI: 10.3390/diagnostics14100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The aim of this study was to establish whether multiple blood parameters might predict an early treatment response to intravitreal bevacizumab injections in patients with diabetic macular edema (DME). Seventy-eight patients with non-proliferative diabetic retinopathy (NPDR) and DME were included. The treatment response was evaluated with central macular thickness decrease and best corrected visual acuity increase one month after the last bevacizumab injection. Parameters of interest were the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), vitamin D, and apolipoprotein B to A-I ratio (ApoB/ApoA-I). The NLR (2.03 ± 0.70 vs. 2.80 ± 1.08; p < 0.001), MLR (0.23 ± 0.06 vs. 0.28 ± 0.10; p = 0.011), PLR (107.4 ± 37.3 vs. 135.8 ± 58.0; p = 0.013), and SII (445.3 ± 166.3 vs. 675.3 ± 334.0; p < 0.001) were significantly different between responder and non-responder groups. Receiver operator characteristics analysis showed the NLR (AUC 0.778; 95% CI 0.669-0.864), PLR (AUC 0.628; 95% CI 0.511-0.735), MLR (AUC 0.653; 95% CI 0.536-0.757), and SII (AUC 0.709; 95% CI 0.595-0.806) could be predictors of response to bevacizumab in patients with DME and NPDR. Patients with severe NPDR had a significantly higher ApoB/ApoA-I ratio (0.70 (0.57-0.87) vs. 0.61 (0.49-0.72), p = 0.049) and lower vitamin D (52.45 (43.10-70.60) ng/mL vs. 40.05 (25.95-55.30) ng/mL, p = 0.025). Alterations in the NLR, PLR, MLR, and SII seem to provide prognostic information regarding the response to bevacizumab in patients with DME, whilst vitamin D deficiency and the ApoB/ApoA-I ratio could contribute to better staging.
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Affiliation(s)
- Karla Katić
- Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia
| | - Josip Katić
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia;
| | - Marko Kumrić
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (J.B.)
| | - Joško Božić
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (J.B.)
| | - Leida Tandara
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia; (L.T.); (D.Š.D.)
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, 21000 Split, Croatia
| | - Daniela Šupe Domić
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia; (L.T.); (D.Š.D.)
- University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia
- Department of Ophthalmology, University of Split School of Medicine, 21000 Split, Croatia
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Gökce SE, Çelik A, Başkan C. The role of blood neutrophil lymphocyte ratio in predicting the initial response to anti-VEGF treatment in neovascular AMD patients. Ir J Med Sci 2024; 193:517-521. [PMID: 37247185 DOI: 10.1007/s11845-023-03379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/18/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Vascular endothelial growth factor (VEGF) has a critical role in age-related macular degeneration (AMD), and intravitreal injection of anti-VEGF drugs is the mainstay of neovascular AMD treatment. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be a biomarker of inflammation in AMD. We aimed to investigate the role of NLR in predicting favorable short-term anti-VEGF treatment results in neovascular AMD patients. METHODS A total of 112 patients diagnosed with exudative AMD and had taken 3 monthly intravitreal bevacizumab injections were analyzed retrospectively. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Best-corrected visual acuity and central macular thickness (CMT) measurements were recorded at each visit. T test or Mann-Whitney U test was used to compare continuous variables, and chi-square test was used to compare categorical variables. Receiver operating characteristics curve (ROC) analysis was performed to determine cut-off, sensitivity, and specificity values. P value of ≤ 0.05 was considered statistically significant. RESULTS The mean age was 68.1 ± 7.2 years, and the mean NLR was 2.11 ± 0.81. The ROC analysis revealed a cut off value of 2.0 for NLR to predict at least 100 μm CMT change (sensitivity 87.1%; specificity 87.8%) and a cut off value of 2.4 for NLR to predict at least 0.1 logMAR visual improvement (sensitivity 77.2%; specificity 64.8%) after 3 monthly IVT bevacizumab injections. CONCLUSION NLR can provide additional prognostic information for the identification of patients with a good initial response to anti-VEGF therapy.
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Affiliation(s)
- Sabite Emine Gökce
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, 06550, Yenimahalle, Ankara, Turkey.
| | - Ayşenur Çelik
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, 06550, Yenimahalle, Ankara, Turkey
| | - Ceyda Başkan
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Liu Y, Zhou Z, Wang Z, Yang H, Zhang F, Wang Q. Construction and clinical validation of a nomogram-based predictive model for diabetic retinopathy in type 2 diabetes. Am J Transl Res 2023; 15:6083-6094. [PMID: 37969206 PMCID: PMC10641351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/14/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE This study aimed to identify risk factors for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) and construct a nomogram prediction model for DR. METHODS T2DM patients (n = 520) who underwent funduscopic examinations from June 2020 to June 2022 were included. Of these patients, 220 had DR, yielding a disease rate of 40.38%. Patients were divided into a training set (n = 364) and a validation set (n = 156) at a 7:3 ratio. Feature variables were selected using LASSO regression, random forests, and decision trees. Venn diagrams identified common DR feature variables. The prediction model's validity was assessed using the C-index, decision curve analysis (DCA), receiver operating characteristic (ROC) curves, and calibration curves. RESULTS Factors influencing DR were age, Diabetic Peripheral Neuropathy (DPN), Hemoglobin A1C (HbA1C) levels, High-Density Lipoprotein (HDL) cholesterol, Low-Density Lipoprotein (LDL) cholesterol, Neutrophil-to-Lymphocyte Ratio (NLR), Triglycerides (TG), Blood Urea Nitrogen (BUN), and disease duration. Univariate analysis excluded LDL as being unrelated to DR. The DR prediction model, constructed using the remaining eight variables, showed internal validation metrics with a C-index of 0.937, area under the ROC curve (AUC) of 0.773, and DCA net benefit of 11%-95%. The external validation metrics demonstrated a C-index of 0.916, AUC of 0.735, and DCA net benefit of 17%-93%. Calibration curves indicated high consistency. CONCLUSION This study developed a nomogram prediction model to assess the risk of DR in patients with T2DM. The model demonstrated high precision through internal validation.
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Affiliation(s)
- Yonghong Liu
- Department of Ophthalmology, Gansu Provincial Hospital of TCMNo. 418 Guazhou Road, Qilihe District, Lanzhou 730050, Gansu, China
| | - Zhaoling Zhou
- Department of Electrocardiogram, Gansu Provincial Hospital of TCMNo. 418 Guazhou Road, Qilihe District, Lanzhou 730050, Gansu, China
| | - Zhiyong Wang
- Trauma Disease Diagnosis and Treatment Center, Gansu Provincial Hospital of TCMNo. 418 Guazhou Road, Qilihe District, Lanzhou 730050, Gansu, China
| | - Huan Yang
- Department of Endocrinology, The Third People’s Hospital of Gansu ProvinceNo. 763 Duanjiatan Road, Chengguan District, Lanzhou 730020, Gansu, China
| | - Feifei Zhang
- Department of Endocrinology, The Third People’s Hospital of Gansu ProvinceNo. 763 Duanjiatan Road, Chengguan District, Lanzhou 730020, Gansu, China
| | - Qinhu Wang
- Department of Endocrinology, The Third People’s Hospital of Gansu ProvinceNo. 763 Duanjiatan Road, Chengguan District, Lanzhou 730020, Gansu, China
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Dascalu AM, Serban D, Tanasescu D, Vancea G, Cristea BM, Stana D, Nicolae VA, Serboiu C, Tribus LC, Tudor C, Georgescu A, Tudosie MS, Costea DO, Bratu DG. The Value of White Cell Inflammatory Biomarkers as Potential Predictors for Diabetic Retinopathy in Type 2 Diabetes Mellitus (T2DM). Biomedicines 2023; 11:2106. [PMID: 37626602 PMCID: PMC10452280 DOI: 10.3390/biomedicines11082106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
The pathogenesis of diabetic retinopathy is still challenging, with recent evidence proving the key role of inflammation in the damage of the retinal neurovascular unit. This study aims to investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) for diabetic retinopathy (DR) and its severity. We performed a retrospective study on 129 T2DM patients, divided into three groups: without retinopathy (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). NLR, MLR, and SII were significantly higher in the PDR group when compared to NDR and NPDR (3.2 ± 1.6 vs. 2.4 ± 0.9 and 2.4 ± 1.1; p = 0.005; 0.376 ± 0.216 vs. 0.269 ± 0.083 and 0.275 ± 0.111, p = 0.001; 754.4 ± 514.4 vs. 551.5 ± 215.1 and 560.3 ± 248.6, p = 0.013, respectively). PDR was correlated with serum creatinine (OR: 2.551), NLR (OR: 1.645), MPV (OR: 1.41), and duration of diabetes (OR: 1.301). Logistic regression analysis identified three predictive models with very good discrimination power for PDR (AUC ROC of 0.803, 0.809, and 0.830, respectively): combining duration of diabetes with NLR, MLR, and, respectively, PLR, MPV, and serum creatinine. NLR, MPV, SII, and LMR were associated with PDR and could be useful when integrated into comprehensive risk prediction models.
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Affiliation(s)
- Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
- Ophthalmology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
| | - Daniela Stana
- Ophthalmology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Vanessa Andrada Nicolae
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
- Ophthalmology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
| | - Adriana Georgescu
- Ophthalmology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Mihail Silviu Tudosie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania (G.V.)
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
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Qin G, Lin T, You Y, Shang M, He W, Pazo EE. Blood inflammatory biomarkers in participants with idiopathic epiretinal membrane: A retrospective case series study. Medicine (Baltimore) 2023; 102:e34225. [PMID: 37390242 PMCID: PMC10313294 DOI: 10.1097/md.0000000000034225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
The objective was to evaluate the levels of monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with idiopathic epiretinal membrane (iERM). This retrospective case series study comprised of participants with iERM and participants with cataract. The values of MLR, NLR, PLR and from participants' peripheral blood were assessed among groups. The best cutoff value of MLR, NLR, and PLR in iERM was found by performing a receiver operating characteristic curve analysis and determining the optimum cutoff value for each variable. In total, 95 participants with iERM were included in the study group, and 61 participants with senile cataract were included as controls. The lymphocyte count in the iERM group was significantly lower than the control group (1.69 ± 0.63 vs. 1.95 ± 0.53, P = .003). The monocyte count in the iERM group was significantly higher than the control group (0.39 ± 0.11 vs. 0.31 ± 0.10, P < .001). The area under the curve of MLR, NLR, and PLR in differentiating patients with IERM and controls was 0.782, 0.645, and 0.657, respectively, according to receiver operating characteristic. The best cutoff value of MLR was > 0.18, with sensitivity and specificity of 74.7% and 75.4%, respectively. The NLR was > 2.06, with a sensitivity and specificity of 50.5% and 83.6%, respectively. The PLR was > 95.89, with a sensitivity and specificity of 86.3% and 41.0%, respectively. The findings of this study suggest that systemic inflammation may be associated with iERM. IERM patients may be prone to have high MLR, NLR, and PLR values.
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Affiliation(s)
| | - Tiezhu Lin
- He Eye Specialist Hospital, Shenyang, China
| | - Yue You
- Sinqi Eye Hospital, Shenyang, China
| | | | - Wei He
- He Eye Specialist Hospital, Shenyang, China
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BEŞİR A, TUĞCUGİL E, AKDOĞAN A, LİVAOĞLU M. Neutrophil/lymphocyte ratio as a predictor of severe postoperative edema and ecchymosis in open rhinoplasty surgery. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1134070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: This study investigated the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and severe postoperative edema and ecchymosis after open rhinoplasty.
Materials and Methods: The study was carried out retrospectively in 165 ASA I-II patients aged 18-45 years who underwent open rhinoplasty in the Department of Plastic and Reconstructive Surgery. The patients were grouped based on their scores on the edema and ecchymosis scales. The degree of edema and ecchymosis was considered “minimal” (Group M) in those scoring 0-2 points and “severe” (Group S) in those scoring 3-4 points. Periorbital edema and ecchymosis of the patients in both groups were scored based on the digital photographs taken on the 1st postoperative day.
Results: There was no significant difference in the demographic and clinical characteristics of the patients grouped according to the degree of edema and ecchymosis. The optimal cut-off value of NLR was 2.1 (AUC = 0.747, Sensitivity = 0.666, Specificity = 0.707) for edema and 1.5 (AUC = 0.747, Sensitivity = 0.869, Specificity = 0.470) for ecchymosis. Multivariable analyzes for the development of edema and ecchymosis identified NLR (4.67 [2.38-9.40] and 6.54 [3.02-15.08, respectively) as a statistically significant independent prognostic factor.
Conclusion: This study identified preoperative NLR as a predictor value of severe postoperative edema and ecchymosis after open rhinoplasty.
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Affiliation(s)
| | | | - Ali AKDOĞAN
- KARADENİZ TEKNİK ÜNİVERSİTESİ, TIP FAKÜLTESİ
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Yuen YS, Tan GSW, Gan NY, Too IHK, Mothe RK, Basa P, Shaikh J. Real-World Evidence in the Management of Diabetic Macular Edema with Intravitreal Anti-VEGFs in Asia: A Systematic Literature Review. Clin Ophthalmol 2022; 16:3503-3526. [PMID: 36274678 PMCID: PMC9579008 DOI: 10.2147/opth.s378392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose To evaluate the visual outcomes and safety profile of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the treatment of diabetic macular edema (DME) in real-world studies in Asian countries. Methods A systematic review of electronic literature databases (Embase, Medline, and the Cochrane Library from January 1, 2010, to March 16, 2021) was conducted to identify observational studies that reported clinical and safety outcomes of anti-VEGF treatments for DME in Asia. We analyzed baseline patient characteristics, treatment patterns, mean number of injections, best-corrected visual acuity (BCVA), retinal thickness, and safety outcomes. Results Seventy-one studies were included in this review. Most studies reported treatment of DME with ranibizumab (n = 33), followed by aflibercept (n = 13), bevacizumab (n = 28), and conbercept (n = 9). At 12 months, the cumulative mean number of injections for ranibizumab, aflibercept, and conbercept was 5.2, 4.6, and 6, respectively. At the 12-month follow-up, the cumulative mean BCVA gain was 6.8 letters (ranibizumab), 4.6 letters (aflibercept), 4.9 letters (bevacizumab), and 8.3 letters (conbercept). The cumulative mean reduction in retinal thickness at 12 months was 116.9 μm (ranibizumab), 105.9 μm (aflibercept), 81.7 μm (bevacizumab), and 135.2 μm (conbercept). A strong positive correlation (r = 0.78) was observed between mean number of injections and change in BCVA at 12 months. A moderate positive correlation (r = 0.54) was observed between mean number of injections and mean reduction in retinal thickness at 12 months. A weak positive correlation was observed between baseline retinal thickness and visual acuity at 12 months. Baseline BCVA and mean number of injections were predictors of BCVA at 12 months. Conclusion All anti-VEGFs were effective in the treatment of DME in Asia. The data suggest that a greater number of anti-VEGF injections was associated with better improvement in BCVA and moderate reduction in retinal thickness at the 1-year follow-up.
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Affiliation(s)
- Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nicola Yi’An Gan
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Issac Horng Khit Too
- Novartis Singapore Pte. Ltd., Mapletree Business City, Singapore,Correspondence: Issac Horng Khit Too, Novartis Singapore Pte Ltd, Mapletree Business City, 20 Pasir Panjang Road #10-25/28, 117439, Singapore, Tel +6567226189, Email
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Karimi S, Arabi A, Shahraki T, Safi S. Association of WBC Counts, Leukocyte Ratios, and Serum Uric Acid with Clinical Outcome of Intravitreal Bevacizumab in Diabetic Macular Edema. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:244-252. [PMID: 35527530 PMCID: PMC9194729 DOI: 10.3341/kjo.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the role of serum uric acid and leukocyte counts and ratios as predictors of clinical outcomes of intravitreal bevacizumab in diabetic macular edema. Method In this prospective study, the patients were treated with three monthly intravitreal bevacizumab. The correlation of serum uric acid and immune cell indices with the changes of best corrected visual acuity and central macular thickness at the end of month 3 were evaluated through univariate and multivariate linear regression analysis. Result A total of 80 eyes from 80 diabetic patients were included in the study. The difference of uric acid level and immune indices between groups with different retinopathy severity was no statistically significant(P>0.05). Lower duration of diabetes (P=0.0451), monocyte count (P=0.021), and uric acid level (P<0.001) were correlated with larger improvement in visual acuity at 3-month visit. Higher logMAR of baseline visual acuity (P=0.007), lymphocyte count (P=0.008), lymphocyte-to-neutrophil ratio (LNR) (P<0.001) and lymphocyte-to-platelet ratio (LPR) (P<0.001) were correlated with larger improvement in visual acuity at 3-month visits. According to multivariate analysis, baseline logMAR (coefficient=0.125, P=0.009), duration of diabetes (coefficient=-0.216, P=0.047), LNR (coefficient=0.712, P<0.001), LPR (coefficient=0.238, P<0.001), and uric acid level (coefficient=-0.397, P<0.001) were the significant predictors of changes in visual acuity in our subset of patients. Conclusion Serum uric acid and leukocyte counts and ratios may predict the response of diabetic macular edema to intravitreal injection.
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Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Özata Gündoğdu K, Doğan E, Çelik E, Alagöz G. Serum inflammatory marker levels in serous macular detachment secondary to diabetic macular edema. Eur J Ophthalmol 2022; 32:3637-3643. [PMID: 35225038 DOI: 10.1177/11206721221083465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the serum inflammatory marker levels in serous macular detachment (SMD) secondary to diabetic macular edema (DME). MATERIAL AND METHODS Patients with DME were divided into two groups according to the presence of SMD. Group 1 consisted of 40 patients with SMD, Group 2 consisted of 40 patients without SMD, and Group 3 consisted of 40 healthy subjects. Neutrophil and mean platelet volume (MPV) were obtained from blood samples. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic immune inflammation index (SII) were calculated. In Group 1 and 2 sub-group analysis was done according to grade of diabetic retinopathy (DR) and the results were analyzed in these subgroups. RESULTS The neutrophils, MPV, NLR, and SII levels were significantly higher in Group 1 (p = 0.000, p = 0.004, p = 0.000, p = 0.001, respectively). In subgroup analysis; the neutrophils, NLR, and SII levels were significantly higher in patients with proliferative DR (p = 0.044, p = 0.046, p = 0.046, respectively) and the SII levels were significantly higher in patients with severe nonproliferative DR in Group 1 (p = 0.039). The mean CMT values were 548.8 ± 138.3 µm in Group 1 and 420.1 ± 112.7 µm in Group 2. The CMT values were significantly higher in Group 1 (p: 0.000). However, there was no significant correlation between the CMT values and the systemic inflamatuar markers levels (p>0.05) in both of the groups. CONCLUSIONS NLR and SII levels were significantly higher in DME with SMD, especially in advanced cases. Elevated serum inflammatory markers might be associated with a higher incidence of SMD.
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Affiliation(s)
- Kübra Özata Gündoğdu
- Department of Ophthalmology, 175679Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Emine Doğan
- Department of Ophthalmology, 175679Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Erkan Çelik
- Department of Ophthalmology, 175679Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Gürsoy Alagöz
- Department of Ophthalmology, 175679Sakarya University Education and Research Hospital, Sakarya, Turkey
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Elbeyli A, Kurtul BE, Ozcan SC, Ozarslan Ozcan D. The diagnostic value of systemic immune-inflammation index in diabetic macular oedema. Clin Exp Optom 2021; 105:831-835. [PMID: 34763621 DOI: 10.1080/08164622.2021.1994337] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
CLINICAL RELEVANCE Diabetic macular oedema (DME) is a significant cause of visual impairment and inflammation plays an important role in its pathophysiology. BACKGROUND This study evaluates the diagnostic value of systemic immune-inflammation index (SII) in the occurrence of DME in patients with non-proliferative diabetic retinopathy. METHODS In this prospective study, the SII was applied to 150 consecutive patients with non-proliferative diabetic retinopathy. The relationship between the SII and the occurrence of DME was examined. Patients with DME were also divided into two subgroups according to the presence of accompanying sub-retinal fluid. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). The risk factors for DME were evaluated using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve analysis of SII for predicting DME was performed. RESULTS Patients with DME had significantly higher levels of SII than those without DME (599.7 ± 279.2 and 464. 9 ± 172.2, respectively, p < 0.001). However, The SII values were similar between sub-retinal fluid subgroups. Multivariate regression analysis indicated that SII, together with duration of diabetes, was an independent factor for DME occurrence [Odds ratio (OR) = 1.005, 95% confidence interval = 1.001-1.009, p = 0.04, and OR = 1.146, 95% CI = 1.049-1.252, p = 0.003, respectively]. ROC curve analysis revealed that the best cut-off value of SII was 399 (area under the curve: 0.633; sensitivity: 70%; specificity: 60%). CONCLUSION An elevated SII value is strongly associated with the development of DME. The SII may be a diagnostic biomarker for identifying DME to improve the risk stratification and management of non-proliferative patients with diabetic retinopathy.
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Affiliation(s)
- Ahmet Elbeyli
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Bengi Ece Kurtul
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Sait Coskun Ozcan
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Deniz Ozarslan Ozcan
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
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Zhang P, Xue WW, Huang XB, Xu Y, Lu LN, Zheng KR, Zou HD. Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai. Int J Ophthalmol 2021; 14:1066-1072. [PMID: 34282393 DOI: 10.18240/ijo.2021.07.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 01/02/2023] Open
Abstract
AIM To investigate the prevalence of diabetic retinopathy (DR) in residents of Shanghai and analyze the risk factors of DR. METHODS This study involved 7233 patients with diabetes in 2016. The demographic data of the participants were collected using a questionnaire survey. Physical examination, laboratory tests, and ophthalmological examinations were conducted. Two professional ophthalmologists diagnosed and graded DR by fundus examination and then combined the results with fundus images. The unconditional multivariate Logistic regression analysis was used to determine the risk factors. RESULTS In total, 6978 patients with type 2 diabetes in Shanghai with a mean age of 68.33±8.40y were recruited, including 2975 males (42.6%) and 4003 females (57.4%). Overall, 1184 patients were diagnosed with DR, with a prevalence rate of 16.97%. Regression analysis showed that duration of diabetes (OR 1.061, 95%CI 1.049-1.073), high systolic blood pressure (SBP; OR 1.071, 95%CI 1.037-1.106), increased glycosylated hemoglobin level (OR 1.234, 95%CI 1.162-1.311), high blood glucose level (OR 1.061, 95%CI 1.023-1.099), increased neutrophil-to-lymphocyte ratio (NLR; OR 1.132, 95%CI 1.053-1.217) and mean platelet volume (MPV; OR 1.077, 95%CI 1.016-1.142) were risk factors of DR. Conversely, hematocrit (HCT; OR 0.971, 95%CI 0.954-0.988) and mean corpuscular volume (MCV; OR 0.980, 95%CI 0.965-0.994) were protective factors. CONCLUSION The prevalence rate of DR in Shanghai is 16.97%. The duration of diabetes, high SBP, increased glycosylated hemoglobin, NLR, and MPV were determined as risk factors of DR.
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Affiliation(s)
- Pei Zhang
- Department of Ophthalmology, Shanghai Gonghui Hospital, Shanghai 200041, China
| | - Wen-Wen Xue
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China
| | - Xiao-Bo Huang
- Department of Ophthalmology, the Second Affiliated Hospital of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Yi Xu
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China
| | - Li-Na Lu
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China
| | - Kai-Rong Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Hai-Dong Zou
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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Vural E, Hazar L. Assessment of Inflammation Biomarkers in Diabetic Macular Edema Treated with Intravitreal Dexamethasone Implant. J Ocul Pharmacol Ther 2021; 37:430-437. [PMID: 33961524 DOI: 10.1089/jop.2020.0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: To evaluate inflammation biomarkers in diabetic macular edema (DME) treated with intravitreal dexamethasone implant (Ozurdex®). Methods: This retrospective single-center study investigated 64 eyes of 64 patients with DME who were nonresponsive to prior antivascular endothelial growth factor and treated with intravitreal Ozurdex. The neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio were calculated. Visual acuity and optical coherence tomography markers, including hyper-reflective dots and subretinal fluid (SRF), were determined, and central retinal thickness was also evaluated monthly for 3 months. Results: The average age was 64.06 ± 7.81 (48-84) years. The baseline NLR and MLR were significantly higher in patients with better visual outcomes (P = 0.029 and P = 0.048, respectively). Better anatomical outcomes were observed in the presence of SRF (P = 0.027). No significant differences were observed in the rates of the presence of SRF and hyper-reflective points about the better functional outcome (P > 0.05). Conclusions: SRF as an imaging biomarker, and NLR and MLR as blood biomarkers, stand out as markers of inflammation and were found to be associated with better response to Ozurdex implantation in DME.
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Affiliation(s)
- Esra Vural
- Department of Ophthalmology, Kayseri City Hospital, Kayseri, Turkey
| | - Leyla Hazar
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
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Koc F, Güven YZ, Egrilmez D, Aydın E. Optical Coherence Tomography Biomarkers in Bilateral Diabetic Macular Edema Patients with Asymmetric anti-VEGF Response. Semin Ophthalmol 2021; 36:444-451. [PMID: 33780313 DOI: 10.1080/08820538.2021.1907423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: This study aimed to identify optical coherence tomography (OCT) biomarkers for predicting response to anti-VEGF treatment in diabetic macular edema (DME)Methods: Bilateral DME patients with asymmetric response to a loading dose of anti-VEGF (ranibizumab/aflibercept) treatment were retrospectively studied. The morphologic response criterion was central subfield thickness (CST) ≤300 µm; asymmetric response was defined as ≥10% difference in CST reduction between the eyes. The functional response criterion was an increase in logMAR acuity of ≥3 lines, with an increase below this threshold in the fellow eye considered asymmetric response. Relationships between final morphologic and functional responses to anti-VEGF therapy and baseline values of the following OCT-derived biomarkers were evaluated: DME subtype, CST, vitreoretinal interface anomalies, disorganization of the inner retinal layers (DRIL), external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption, and subretinal fluid (SRF).Results: After a loading dose of anti-VEGF, 31 eyes that met both morphologic and functional response criteria were classified as responders (RR) and 27 eyes that did not respond morphologically or functionally based on the defined criteria were classified as resistant (RT). Eyes that showed only functional (n = 5) or morphological response (n = 1) were excluded due to their small number. The presence of SRF or simple epiretinal membrane (ERM) was not associated with any difference in treatment responses (p > .05), while tractional ERM, extensive DRIL (≥500 µm), and ELM and EZ disruptions in the fovea-centered 1000-µm zone were important OCT biomarkers in predicting resistance (p < .001). A multilayer perceptron model ranked predictive power as 100% for ELM disruption, 51.7% for tractional ERM, 25.4% for DRIL, and 24.5% for EZ disruption.Conclusion: Extensive ELM disruption was the strongest OCT biomarker to predict anti-VEGF resistance, followed by tractional ERM. EZ disruption and DRIL had relatively lower predictive value.
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Affiliation(s)
- Feray Koc
- Medicine, Department of Ophthalmology, Izmir Katip Celebi University, Izmir, Turkey
| | - Yusuf Ziya Güven
- Medicine, Department of Ophthalmology, Izmir Katip Celebi University, Izmir, Turkey
| | - Deniz Egrilmez
- Department of Ophthalmology, Ataturk Education and Research HospitalEye Clinic, Izmir, Turkey
| | - Erdinç Aydın
- Medicine, Department of Ophthalmology, Izmir Katip Celebi University, Izmir, Turkey
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Yalinbas Yeter D, Eroglu S, Sariakcali B, Bozali E, Vural Ozec A, Erdogan H. The Usefulness of Monocyte-to-High Density Lipoprotein and Neutrophil-to-Lymphocyte Ratio in Diabetic Macular Edema Prediction and Early anti-VEGF Treatment Response. Ocul Immunol Inflamm 2021; 30:901-906. [PMID: 33596398 DOI: 10.1080/09273948.2020.1849739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To determine the association of monocyte-to-high-density lipoprotein ratio (MHR) and neutrophil-to-lymphocyte ratio (NLR) with diabetic macular edema (DME) and early anti-VEGF treatment response.Material methods: This was a retrospective and cross-sectional study conducted with 143 patients with diabetes mellitus (53 diabetic retinopathy with DME, 38 diabetic retinopathy without DME, and 52 without diabetic retinopathy).Results: 13.9 was the best cutoff value to predict DME for MHR, and 2 was for NLR (59% and 75% sensitivity and 81% and 59% specificity, respectively). Logistic regression analysis showed that NLR≥2 and MHR≥13.9 were significantly associated with DME prediction. However, neither NLR≥2 nor MHR≥13.9 was associated with central retinal thickness(CRT) or best corrected visual acuity(BCVA) outcomes after anti-VEGF treatment. On the other hand, increased NLR was associated with inferior CRT outcomes.Conclusion: MHR and NLR were simple and cost-effective biomarkers to predict DME. Moreover, higher NLR may contribute to poor CRT outcomes.
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Affiliation(s)
- Duygu Yalinbas Yeter
- Faculty of Medicine, Department of Ophthalmology, Cumhuriyet University, Sivas, Turkey
| | - Serap Eroglu
- Faculty of Medicine, Department of Ophthalmology, Cumhuriyet University, Sivas, Turkey
| | - Baris Sariakcali
- Faculty of Medicine, Department of Endocrinology and Metabolism, Cumhuriyet University, Sivas, Turkey
| | - Erman Bozali
- Faculty of Medicine, Department of Ophthalmology, Cumhuriyet University, Sivas, Turkey
| | - Ayse Vural Ozec
- Faculty of Medicine, Department of Ophthalmology, Cumhuriyet University, Sivas, Turkey
| | - Haydar Erdogan
- Faculty of Medicine, Department of Ophthalmology, Cumhuriyet University, Sivas, Turkey
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