Emine TINKIR KAYITMAZBATIR, Gülfidan BİTİRGEN, Günhal ŞATIRTAV, İbrahim KILINC, Mustafa KULAKSIZOĞLU, Bülent SAVUT, Hürkan KERİMOĞLU

Kan şekeri regüle olmayan hastalarda kısa dönem glisemik control ve intravitreal ranibizumab tedavisinin serum sitokin düzeyleri ve diyabetik maküler ödem üzerine etkisi

Amaç: Glisemik kontrol ve intravitreal ranibizumab tedavisinin diyabetik maküla ödemi (DMÖ) üzerindeki kısa vadeli etkisini ve HbA1c ile belirli serum sitokinleri arasındaki korelasyonu değerlendirmek. Tasarım: Prospektif çalışmaya HbA1c seviyeleri 53 mmol/mol (%7) üzerinde ve spektral domain optik koherens tomografi (SDOKT) ile DMÖ tespit edilmiş 43 katılımcı dahil edildi. Katılımcılar: Katılımcılar, başlangıç en iyi düzeltilmiş uzak görme keskinliklerine (EDGK) göre gruplandırıldı. Grup 1, üç doz aylık intravitreal ranibizumab (0.5 mg) enjeksiyonu ile tedavi edilirken, Grup 2’deki katılımcılar intravitreal tedavi uygulanmadan takip edildi. Yöntem: İnterlökin (IL)-1β, IL-6, IL-8, tümör nekroz faktörü-alfa (TNF-a), monosit kemoatraktan protein-1(MCP-1) ve vasküler endotelyal büyüme faktörü (VEGF) dahil olmak üzere serum sitokin seviyeleri, enzime bağlı immünosorbent testi (ELISA) kullanılarak 3 aylık takibin başında ve sonunda analiz edildi. Bulgular: Grup 1’in maküla kalınlıklarında (bir kadran hariç) anlamlı azalma gözlendi. Serum sitokin seviyelerindeki değişiklikler HbA1c düşüşü ile korele bulunmadı. Grup 1'de intravitreal tedaviye rağmen serum VEGF düzeyi anlamlı olarak yükseldi. Sonuç: Kısa süreli glisemik kontrolün tek başına DMÖ tedavisindeki yeri sınırlıdır. İntravitreal tedavinin DMÖ üzerindeki terapötik etkisi, lokal sitokin ortamının patofizyolojideki rolünü desteklemektedir

Anahtar Kelimeler:

Diyabetes Mellitus, Tip 2, Glisemik Kontrol, Glikolize Hemoglobin A1c, Maküler Ödem, Serum Sitokinleri, Vasküler Endotelyal Büyüme Faktörü

Short-term impact of glycaemic control and intravitreal ranibizumab treatment on serum cytokine levels and diabetic macular edema in patients with unregulated blood glucose

Objective: To evaluate the short-term effect of glycaemic control and intravitreal ranibizumab treatment on diabetic macular edema (DME) and to assess the correlation between HbA1c and certain serum cytokines. Design: A prospective study of 43 participants with HbA1c levels exceeding 53 mmol/mol (7%) and with DME, as detected by spectral domain optical coherence tomography (SDOCT). Subjects: Participants were grouped according to their initial best corrected distance visual acuity (BCVA). Group 1 was treated with three monthly doses of intravitreal ranibizumab (0.5 mg) injections, and Group 2 was followed without treatment. Methods: Serum cytokine levels, including interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1(MCP-1), and vascular endothelial growth factor (VEGF) were analysed at the beginning and at the end of 3 months, using enzyme-linked immunosorbent assays (ELISA). Results: A significant decrease in macular thicknesses (except for one quadrant) was observed in Group. Changes in serum cytokine levels were not correlated with HbA1c decrease. Serum VEGF level was significantly increased in Group 1, despite the intravitreal treatment. Conclusion: Short-term glycaemic control alone had limited value in the treatment of DME. The therapeutic effect of intravitreal treatment on DME supports the role of the local cytokine milieu in the pathophysiology.

Keywords:

Diabetes Mellitus, Type 2, Glycaemic Control, Glycated Haemoglobin A1c, Macular Edema, Serum Cytokines, Vascular Endothelial Growth Factor,

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