| Purpose:To investigate the efficacy of intravitreal ranibizumab(IVR)in the treatment of macular edema secondary to branch retinal vein occlusion(BRVO-ME)in young adults and the elderly.At the same time,the expression levels of vascular endothelial growth factor(VEGF),interleukin 6(IL-6)and interleukin 8(IL-8)in aqueous humor of patients with BRVO-ME were observed before and after IVR treatment,and correlation analysis was conducted,so as to explore the possible pathogenesis of BRVO-ME and the effectiveness of intervention measures.Methods:A prospective clinical study was conducted.52 eyes of 52 patients with non-ischemic BRVO-ME who met the inclusion and exclusion criteria and were confirmed by the ophthalmic examination in our hospital from January 2022 to January 2023 were included in the study.All patients were divided into 2 groups based on their age:22 eyes of 22 patients in the young and middle-aged group(age≤50 years old)and 30 eyes of 30 patients in the elderly group(age>50 years old).The central macular thickness(CMT),best-corrected visual acuity(BCVA)and intraocular pressure(IOP)were recorded and compared at baseline before the first treatment and 1 week after the first vitreous humor injection of ranibizumab.Aqueous humor was collected before and after IVR treatment to observe the differences of VEGF,IL-6 and IL-8 concentrations in aqueous humor before and after the IVR treatment,and analyze the correlation with treatment response.Results:1.Comparison between the young and middle-aged group and the elderly group at baseline:1)There was no statistically significant difference between the two groups in terms of baseline gender,eye category,disease duration,IOP(all P>0.05);2)There was no significant difference in baseline BCVA and CMT between the two groups(P=0.528,P=0.742);3)There was no significant difference in VEGF level in aqueous humor between the two groups(P=0.781);The levels of IL-6 and IL-8 in aqueous humor of the young and middle-aged group were higher than those of the elderly group,there was statistical significance(P=0.027,P=0.041).2.Comparison between the young and middle-aged group and the elderly group after 1 week of IVR treatment:1)BCVA was better in the old patient group than in the young and middle-aged group after 1 week of IVR treatment,with a statistically significant difference(P=0.037),and CMT in the old patient group was thinner than that in the young and middle-aged group,with a statistically significant difference(P=0.030);2)After 1 week of IVR treatment,there was no significant difference in VEGF level in aqueous humor between the two groups(P=0.051).The decrease rate of VEGF in aqueous humor was higher in the elderly group than in the young and middle-aged group,and the difference was statistically significant(P=0.021).The levels of IL-6 and IL-8 in aqueous humor in the young and middle-aged group were higher than those in the elderly group,and the difference was statistically significant(P=0.025,P=0.042);3.Comparison of young and middle-aged group before and after IVR treatment:1)BCVA and CMT after IVR treatment were significantly improved compared with those before treatment,with statistically significant differences(all P<0.05);2)VEGF levels in aqueous humor decreased significantly after IVR treatment compared with those before treatment,with statistical significance(P=0.000).There was no significant difference in IL-6 and IL-8 levels in aqueous humor after IVR treatment compared with before treatment(P=0.072,P=0.638);4.Comparison of IVR before and after treatment in the old patient group:1)BCVA and CMT after IVR treatment were significantly improved compared with those before treatment,and the difference was statistically significant(all P<0.05);2)VEGF level in aqueous humor decreased significantly after IVR treatment compared with before treatment,and the difference was statistically significant(P=0.000).There was no significant difference in IL-6 and IL-8 levels in aqueous humor after IVR treatment(P=0.051,P=0.727);5.The levels of IL-8 and VEGF in aqueous humor at baseline were positively correlated with CMT(r_s=0.470,0.278,all P<0.05).6.VEGF and IL-6(r_s=0.276,P<0.05)and IL-8(r_s=0.410,P<0.05)levels in aqueous humor at baseline in BRVO-ME patients were significantly and positively correlated;7.There was no significant correlation between baseline VEGF and IL-6 level in aqueous humor and the reduction of CMT(r_s=0.201,p=0.153;r_s=0.110,P=0.438).There was a positive correlation between baseline IL-8 level in aqueous humor and the reduction of CMT(r_s=0.309,P=0.026<0.05);8.After IVR,the decrease rate of VEGF in aqueous humor of BRVO-ME was positively correlated with the decrease rate of CMT(r_s=0.377,P=0.006<0.05).Conclusion:1.The degree of macular edema following the onset of branch retinal vein occlusion was not significantly different between young and old adults,which was related to the increased expression levels of VEGF,IL-6 and IL-8 factors in aqueous humor.Inflammatory factors were more pronounced in young and middle-aged adults.2.The treatment of BRVO-ME with anti-VEGF drugs(ranibizumab)significantly improved the vision of patients and reduced CMT,which was significantly improved 1 week after injection.3.Older patients have better short-term results with improved visual acuity and thinner CMT compared to young and middle-aged patients with ranibizumab.Young patients may require intensive anti-inflammatory therapy.4.Ranibizumab could significantly reduce the level of VEGF in aqueous humor of BRVO-ME patients,but had no significant effect on IL-6 and IL-8 levels in aqueous humor in the short term.5.The expression levels of IL-8 and VEGF in aqueous humor at baseline were positively correlated with CMT,and the expression levels of IL-8 and VEGF might be related to the progression of BRVO-ME lesions.6.VEGF expression levels in aqueous humor at baseline in BRVO-ME patients were positively correlated with IL-6 and IL-8 expression levels,and there may be a correlation between ischemia and inflammatory status after the onset of BRVO-ME.7.IL-8 expression levels in aqueous humor at baseline in BRVO-ME patients were positively correlated with CMT reduction,and baseline IL-8 expression levels may affect the prognosis of BRVO-ME patients.8.Changes in VEGF in aqueous humor of BRVO-ME patients after IVR correlate with treatment response. |
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