Effect of aflibercept combined with triamcinolone acetonide on aqueous humor growth factor and inflammatory mediators in diabetic macular edema

Systematic Inflammation and Oxidative Stress Elevation in Diabetic Retinopathy and Diabetic Patients with Macular Edema

This study investigates the association between diabetic retinopathy (DR) and its complication, diabetic macular edema (DME), and compared it with biomarkers of oxidative stress. This study aimed to compare the main indicators of the development of diabetic retinopathy measured as parameters of oxidative stress and compared to lipid oxidation, DNA damage, and cytokine levels and to monitor their quantitative manifestation in DME. This study evaluated 134 patients (62 males and 72 females; aged 62.10 ± 11.22 years) and divided them into two groups: type 2 diabetes mellitus with DR and type 2 diabetes mellitus with DME. All results were compared with healthy volunteers (n = 94) and showed that patients with DME had significantly higher levels of ROS, cytokine production, lipid oxidation, and DNA damage. In addition, patients with DME had decreased levels of nitric oxide (NO) and an impaired NO synthase (NOS) system (p < 0.05). These findings suggest that patients with DR and DME are unable to compensate for high levels of oxidative stress. Reduced NO levels in patients with DME may be due to impaired NO availability. This study highlights compromised oxidative status as a contributing factor to DME in patients with decompensated type 2 diabetes mellitus. An assessment of oxidative stress levels and inflammatory biomarkers may aid in the early detection and prediction of diabetic complications.

Aflibercept combined with triamcinolone acetonide in the treatment of diabetic macular edema: optical coherence tomography and optical coherence tomography angiography

AIM

To analyze the relationship between optical coherence tomography (OCT) and OCT angiography (OCTA) imaging in patients with diabetic macular edema (DME) who are treated with a combination of aflibercept and triamcinolone acetonide (TA).

METHODS

A total of 76 eyes newly diagnosed DME were included in this study. They were randomly assigned to receive either aflibercept or a combination of aflibercept and TA. Injections once a month for a total of three injections. Central macular thickness (CMT), number of hyperreflective foci (HRF), height of subretinal fluid (SRF), and area of foveal avascular zone (FAZ) were evaluated using OCT and OCTA at baseline and after each monthly treatment.

RESULTS

Both groups showed improvement in best corrected visual acuity (BCVA) and reduction in macular edema after treatment, and the difference in BCVA between the two groups was statistically significant after each treatment (P<0.05). The difference in CMT between the two groups was statistically significant after the first two injections (P<0.01), but not after the third injection (P=0.875). The number of HRF (1mo: 7.41±8.25 vs 10.86±7.22, P=0.027; 2mo: 5.33±6.13 vs 9.12±8.61, P=0.034; 3mo: 3.58±3.00 vs 6.37±5.97, P=0.007) and height of SRF (1mo: 82.39±39.12 vs 105.77±42.26 µm, P=0.011; 2mo: 36.84±10.02 vs 83.59±37.78 µm, P<0.01; 3mo: 11.57±3.29 vs 45.43±12.60 µm, P<0.01) in combined group were statistically significant less than aflibercept group after each injection, while the area of FAZ showed no significant change before and after treatment in both groups.

CONCLUSION

The combination therapy of aflibercept and TA shows more significant effects on DME eyes with decreased HRF and SRF. However, both aflibercept and combination therapy show no significant change in the area of FAZ.