The Study Of IL-1,TNF-α In Aqueous Humor Of Secondary Glaucoma After Vitrectomy And Silicon Oil Injection In Patients With Retinal Detachment

Objective: Pars plana vitrectomy and silicon oil is effective in the treatment of complicated retinal detachment. With the extensive application of intraocular silicon oil injection in the vitreous operation, the complications which have been brought about by the intraocular silicon oil injection are drawing more and more attention. Among them, secondary glaucoma could strongly influence the visual performance of the optic nerve, if not cured soon enough, it could result in the permanent and irreversible visual function impairment. The pathogenesis of the glaucoma brought about by the silicon oil injection is unknown, and the literature tends to analyze its risk factors from the point of mechanical obstruction. Clinical observation shows that the patients who have longer period of postoperative inflammatory reaction have greater chances of having secondary glaucoma. It has not been reported in the current literature whether chronic inflammatory mechanism is involved in the pathogenesis of glaucoma secondary to silicone oil eyes. IL-1,TNF-αare two important proinflammation cytockines with multiple biological effects, which are the center medium of inflammation and immune responses. They could stimulate macrophage to secrete inflammatory chemokine, promote the accumulation of inflammatary corpuscle, repair the damage of tissue, induce the formation of blood vessels and connective tissue, etc. There have been many literature reports of IL-1,TNF-αrelated to the occurrence and development of many eye diseases. This study is to determine and compare the concentration of IL-1,TNF-αin aqueous humor of secondary glaucoma after vitrectomy and silicon oil intraocular injection in patients with rhegmatogenous retinal detachment, and explore its pathogenesis in the silicon oil glaucoma, and hope to provide an entry point for clinical treatment.Methods: The patients whose tension of eyeballs and the fundus are in a stable condition after vitrectomy and silicon oil intraocular injection in patients with rhegmatogenous retinal detachment, postoperative secondary glaucoma and those intraocular pressure in normal range, received the operation of silicon oil removal or trabeculectomy at the same time from Jan.2009 to Dec.2009 were chosen as the subjects. Meanwhile, the patients who had received phacoemulsification and intraocular lens implantation for simple cataract in the corresponding period were chosen as the subjects in order to make a comparison. None of the selected patients had diseases such as primary glaucoma,uveitis,other immune-related eye diseases,and diabetes,systemic inflammatary diseases or other systemic diseases. The subjects were divided into three groups. In groupⅠwere patients who had silicon oil glaucoma after vitrectomy and silicon oil intraocular injection. There were 14 eyes of 14 cases in it, with 9 men and 5 women, 7 right eyes and 7 left eyes. The age of the patients ranged from 36 to 75, with the average age 54.14±10.97. In groupⅡwere patients whose intraocular pressure were in normal range after vitrectomy and silicon oil intraocular injection. There were 16 eyes of 16 cases , with 9 men and 7 women, 7 right eyes and 9 left eyes. The age of the patients ranged from 27 to 68, with the average age 51.86±10.96. In groupⅢwere patients who performed phacoemulsification and intraocular lens implantation for simple cataract. There were 17 eyes of 17 cases , with 7 men and 10 women, 7 right eyes and 10 left eyes. The age of the patients ranged from 45 to 76, with the average age 60.06±6.84.All the patients were operated on following the routine sterilization, put on the sterile towel and opened the eyelids with eyelid opener. About 0.1~ 0.2ml aqueous humor was obtained by sticking into the chamber within 0.5~1mm inside the limbus with 1ml disinfected syringe. Put the specimens into the 0.5ml sealing Eppendorf test tubes and marked with numbers , the aqueous humor samples were stored in the -70℃cryogenic refrigerator for spare use. The contents of IL-1βand TNF-αin the samples were measured by radioimmunoassay. The experiment was performed by professionals strictly following the instructions given in the kits. All the data obtained from the experiment were analyzed by SAS V8 software to test its normality and homogeneity of variance. Mean comparison in groups was conducted with single factor variance analysis when the data were fit with normality distribution and equal variance, and the pairwise comparison was performed with SNK-q method. Mean comparison in groups was conducted with rank sum test when the data were not fit with normality distribution or equal variance. T-test was performed to compare the two-sample mean.Comparison of rate was conducted with chi-square test.Results: In groupⅠ, of the 14 aqueous humor samples, TNF-αwas detected in 14 cases and its average content was 1.0404±0.2449ng/ml . IL-1βwas detected in 12 cases and its average content was 0.2346±0.2080ng/ml. The time of silicon oil removal ranged from 3 months to 4 years, with the average time 12.0710±11.1390 months. The duration of higher intraocular pressure ranged from 1.5 months to 11 months, with the average time 4.7143 months. The highest intraocular pressure ranged from 25.7mmHg to 57mmHg, with the average intraocular pressure 41.20±9.85mmHg. In groupⅡ, of the 16 aqueous humor samples,TNF-αwas detected in 16 cases and its average content was 0.6894±0.3152ng/ml . IL-1βwas detected in 14 cases and its average content was 0.2147±0.2718 ng/ml. The time of silicon oil removal ranged from 3 months to 2 years, with the average time 8.3750±6.4382 months. In groupⅢ, of the 17 aqueous humor samples, TNF-αwas detected in 17 cases and its average content was 0.7099±0.1992 ng/ml. IL-1βwas detected in 15cases and its average content was 0.1639±0.1406 ng/ml. Through statistical analysis, the differences in the contents of TNF-αin the aqueous humor samples of each group were obvious and had statistical significance(F=8.65, P=0.0007,P<0.05). There were obvious differences between the groupⅠand the other two groups . This showed statistical significance . However, the groupⅡand the groupⅢhad no obvious differences, showing no statistical significance. There were no obvious differences in the contents of IL-1βof the samples in each group, which showed no statistical significance(P=0.4351,P>0.05). The mean time of silicon oil removal of the groupⅠand the groupⅡhad no obvious differences, showing no statistical significance(t=1.09 P=0.2876 P>0.05). There were no obvious differences in rate of silicon oil emulsification in groupⅡand groupⅢ, which showed no statistical significance(P=1.0000 ,P>0.05).Conclusion: 1,No siganificant difference was found in the content of IL-1 in test group and control group after the statistical analysis. IL-1 is not likely to participate in the secondary glaucoma after vitrectomy and silicon oil injection in patients with rhegmatogenous retinal detachment.2,The content of the TNF-αin the patients of secondary glaucoma after vitrectomy and silicon oil injection in patients with rhegmatogenous retinal detachment is obviously higher, hence, TNF-αmay be a significant factor in the pathogenesis of the silicon oil glaucoma.