Risk Factors Of Retinal Vein Occlusion And Prognostic Factors Associated With Macular Edema

Objective:To study the risk factors associated with retinal vein occlusion?RVO?and the correlations between the aqueous humor cytokine levels and the severity of macular edema?ME?,the speed of ME recovery after anti-vascular endothelial growth factor?VEGF?therapy,as well as the time of ME recurrence in RVO patients.Methods:1.Gathering 51 patients who were diagnosed with RVO in the outpatient clinic of our hospital from September 2018 to September 2019as the experimental group.And collecting 51 patients with health examination as the control group.All subjects took fasting blood,and detected the level of plasma homocysteine?Hcy?,fasting blood glucose?FBG?,triglyceride?TG?,total cholesterol?TC?,high density lipoprotein cholesterol?HDL-C?,low density lipoprotein cholesterol?LDL-C?,whole blood viscosity?WBV?and plasma viscosity?PV?.Data analysis was performed using SPSS 25.0 statistical analysis software.2.This was a prospective study.Forty-seven cases with ME from RVO and 32 cases with senile cataract were included in the study.They were diagnosed in the outpatient clinic of our hospital from December 2018 to September 2019.The 32 cases with senile cataract and no other eye disorders were served as the control group.An anterior chamber paracentesis and 50?l aqueous humor collection were performed in patients with ME before the intravitreal injection of Ranibizumab,and in patients with cataract before the cataract surgery.The levels of VEGF,monocyte chemoattractant protein-1?MCP-1?,interleukin 8?IL-8?,IL-6,basic fibroblast growth factor?b-FGF?,and tumor necrosis factor-??TNF-??in the aqueous humor were measured using cytometric beads array(BD^TM CBA).Then the patients with ME from RVO were intravitreally injected 0.5mg?10mg/ml?Ranibizumab.The maximum values of the central retinal thickness?CRT?were measured by using spectral-domain optical coherent tomography?SD-OCT?before the Ranibizumab treatment and during each follow-up visits after the treatment.The recovery speed of the Ranibizumab treatment was calculated by using a formula:CRT_BT-CRT_AT1W/CRT_BT.In which CRT_BTT was the CRT measured before the treatment,and CRT_AT1WT1W was measured one week after the treatment.The recurrence time of ME was recorded.A statistical analysis software?SPSS25.0?was applied in the study.Results:1.Compared with control group,the levels of Hcy,FBG,TG,TC and WBV were increased in RVO,and the differences were statistically significant?P<0.01?;there were no significant differences between the two groups of HDL-C,LDL-C and PV?P>0.05?.2.Hcy,FBG,TG,TC,and low shear rate 1 sec^-11 of WBV were independent risk factors for RVO.For each additional unit of Hcy,FBG,TG,TC,and low shear rate 1 sec^-1,the risk of RVO would increase by1.239 times?P=0.009;95%CI,1.056-1.453?,4.907 times?P=0.003;95%CI,1.742-13.820?,7.215 times?P=0.005;95%CI,1.804-28.863?,3.299times?P=0.04;95%CI,1.058-10.293?,and 1.336 times?P=0.048;95CI%,1.003-1.779?.3.The levels of VEGF,MCP-1,IL-8,and IL-6 in the aqueous humor of the patients with ME were higher than those in the controls.The differences were statistically significant?P<0.01?.4.The pre-treatment levels of VEGF,MCP-1,IL-8,and IL-6 in the aqueous humor of the patients with ME were positively correlated with the CRT_BT?P<0.05?.5.The level of VEGF in the aqueous humor of the patients with ME was positively correlated with CRT_BT-CRT_AT1w/CRT_BT?r=0.411,p=0.046?.6.After the Ranibizumab treatment,CRT were significantly reduced compared to the CRT_BT?P<0.05?.7.The mean recurrence time of ME was 43.5 days?ranged from 20days to 157 days?after the first intravitreal injection of Ranibizumab.The level of IL-6 in the aqueous humor of patients with ME was negatively correlated with the recurrence time of ME?r=-0.551,P=0.027?.Conclusion:1.The levels of Hcy,FBG,TG,TC,WBV were increased in RVO.Increased Hcy,FBG,TG,TC,and low shear rate 1 sec^-11 of WBV are independent risk factors for RVO.2.The levels of VEGF,MCP-1,IL-8,and IL-6 in the aqueous humor were significantly increased in patients with RVO-ME.The higher levels of VEGF,MCP-1,IL-8,and IL-6 in the aqueous humor,the thicker of CRT and more severe of their ME.Ranibizumab reduced CRT in the patients with RVO-ME.Higher levels of VEGF were an indicator of quicker CRT recovery after ranibizumab therapy.Higher levels of IL-6 were an indicator of quicker recurrence of ME after the first ranibizumab treatment.