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Xu Q, Gong C, Qiao L, Feng R, Liu H, Liu Y, Yang L, Fan W, Guan L, Li J, Zhang Y, Li S. Downregulation of angiogenic factors in aqueous humor associated with less intraoperative bleeding in PDR patients with NVG receiving conbercept: a randomized controlled trial. BMC Ophthalmol 2022; 22:224. [PMID: 35585570 PMCID: PMC9115965 DOI: 10.1186/s12886-022-02451-6] [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: 07/08/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze the level changes of 28 cytokines in aqueous humor of patients with proliferative diabetic retinopathy (PDR) coexisting neovascular glaucoma (NVG) after intravitreal injection of conbercept (IVC), and to investigate whether these cytokines are associated with intraoperative bleeding (IOB). METHODS Totally 34 eyes with NVG secondary to PDR were enrolled. Patients were randomized into two groups, and all of them underwent 25-gauge pars plana vitrectomy (PPV) combined with trabeculectomy. Group I, 18 eyes received IVC 3 days before PPV, and 100 µL aqueous humor was collected at the time of IVC pretreatment and 3 days later at the beginning of PPV respectively. Group II, 16 eyes received IVC after PPV, and 100 µL aqueous humor was collected only at the beginning of PPV. Aqueous humor from 19 eyes with age-matched cataract patients served as controls. Luminex bead-based multiplex array was used to measure the levels of 28 cytokines in aqueous humor. The baseline cytokine levels were compared among the three groups. All NVG patients were divided into IOB and non-bleeding (INB) groups. The cytokine levels of aqueous humor at the beginning of PPV were compared between group I and II, also between IOB and INB groups. IOB in NVG patients was graded according to vitreous bleeding amount. The correlation between cytokine levels and the grades of IOB were analyzed. RESULTS Compared with controls, the baseline levels of 18 cytokines associated with inflammation and angiogenesis showed significantly increased in group I and group II (all, P < 0.0167). The IOB rate as well as the levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A in group I were significantly lower than in group II (all, P < 0.05). The levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A were significantly lower in INB group than in IOB group (all, P < 0.05). The levels of IL-4, Ang-2, PLGF and VEGF-A were positively correlated with the grades of IOB in NVG patients (all, rs > 0.4, P < 0.05). CONCLUSIONS IVC 3 days before PPV combined with trabeculectomy reduces IOB in NVG patients, in which the downregulation of IL-4, Ang-2, PLGF and VEGF-A after IVC may be an underlying mechanism. TRIAL REGISTRATION ChiCTR2100048118 , retrospectively registered on 2 July 2021.
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Affiliation(s)
- Qing Xu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Chaoju Gong
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Lei Qiao
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Ruifang Feng
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Haiyang Liu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Yalu Liu
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Liu Yang
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Wei Fan
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Lina Guan
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Jie Li
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Yipeng Zhang
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China
| | - Suyan Li
- Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China.
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Budzinskaya MV, Shelankova AV, Andreeva YS. [Prevention of intraocular pressure elevation following intravitreal injections]. Vestn Oftalmol 2022; 138:240-246. [PMID: 36287162 DOI: 10.17116/oftalma2022138052240] [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] [Indexed: 06/16/2023]
Abstract
Determining the role of vascular endothelial growth factor (VEGF) in the pathogenesis of intraocular neovascularization prompted the development of anti-VEGF therapy. In general, these intravitreal injections (IVI) are considered relatively safe. One of the side effects that can occur after IVI of anti-VEGF agents is ocular hypertension, it can be acute or persistent. Numerous studies investigating the prevention of ophthalmic hypertension have been carried out in connection with the proven risk of short-term intraocular pressure (IOP) elevation after anti-VEGF injections. Scientific literature describes several methods of preventing intraocular pressure spikes after IVI: prophylactic medications, anterior chamber paracentesis, scleral decompression. Despite the significant number of publications, there is no universal consensus on the necessity of prevention measures for IVI of anti-VEGF drugs since the clinical benefits of slightly reducing the short-term IOP spikes remain unclear. This literature review analyzes the prospects of preventing ocular hypertension after IVI of anti-VEGF agents.
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