Significance of monitoring vascular endothelial growth factor, monocyte chemoattractant protein-1 and Interleukin-8 in diabetic macular edema towards early identification of nonresponders to ranibizumab therapy

• Published in: Indian journal of ophthalmology 2021-06, Vol.69 (6), p.1475-1481
• Main Authors: Xavier, Tessy, Pallikara, Swetha, Saji, Neha, Radhakrishnan, Natasha, Menon, Krishnakumar, Pillai, Gopal
• Format: Article
• Language: English
• Subjects: Acuity; anti-vegf therapy; bcva; Chemokines; cmt; Cytokines; Diabetes; Diabetes mellitus; diabetic macular edema; Diabetic retinopathy; Disease management; Drug therapy; Drug utilization; Edema; Eye diseases; Health aspects; Inflammation; Interleukin 8; Methods; Monoclonal antibodies; Monocyte chemoattractant protein; Monocyte chemoattractant protein 1; Monocytes; Original; Patients; Population studies; Prognosis; ranibizumab; Vascular endothelial growth factor; vegf
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_3109_20

Purpose: Identification of nonresponders prior to anti-vascular endothelial growth factor (anti-VEGF) therapy would help in the judicious clinical management of diabetic macular edema (DME) patients. Thus, a systematic study was initiated to identify nonresponding DME patient population undergoing ranibizumab treatment to figure out additional inflammatory components that may contribute to their nonresponsiveness to anti-VEGF therapy. Methods: A total of 40 patients recruited to this investigator-initiated trial received intravitreal ranibizumab monthly for 3 months. The fourth- and fifth-month injections were according to PRN protocol and the sixth-month injection was mandatory. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and VEGF in aqueous humor were measured for all the patients. Patients were grouped into responders/nonresponders on the formulated criteria and the levels of key pro-inflammatory cytokines were also measured between the two groups at baseline, 2 month and 5 months using cytometric bead array (CBA). Results: Eleven patients were categorized (29.72%) as responders and 10 patients (27.02%) as nonresponders. Nonresponders showed poorer BCVA (P = 0.024, 0.045, and 0.048 for 4, 5, and 6 months) and higher CMT (P = 0.021, 0.0008 and