Safety and Feasibility of Quantitative Multiplexed Cytokine Analysis From Office-Based Vitreous Aspiration.

PURPOSE: The goals of this study were to evaluate the safety of office-based vitreous sampling, and determine the utility of these samples with multiplex cytokine analysis. METHODS: Vitreous samples were collected from office-based needle aspiration and the rate of adverse events during follow-up was reviewed. The vitreous cytokine concentrations in a subset of patients with diabetic macular edema (DME) were analyzed using a 42 plex-cytokine bead array. These results were compared with vitreous cytokine concentrations in proliferative diabetic retinopathy (PDR) and controls (macular hole, epiretinal membrane, symptomatic vitreous floaters) from pars plana vitrectomy. RESULTS: An adequate volume of vitreous fluid (100-200 µL) was obtained in 52 (88%) of 59 office-based sampling attempts. The average length of follow-up was 300 days (range, 42-926 days). There were no complications, including cataract, retinal tear or detachment, and endophthalmitis. Two patients (3%) had posterior vitreous detachments within 3 months. Vitreous cytokine concentrations were measured in 44 patients: 14 controls, 13 with DME, and 17 with PDR. The concentration of ADAM11, CXCL-10, IL-8, and PDGF-A were higher in PDR compared with controls and DME. The concentration of IL-6 was higher in PDR compared with controls, but not compared with DME. CONCLUSIONS: Office-based vitreous aspiration is safe and yields high-quality samples for multiplex vitreous cytokine analysis. Significant elevations of vitreous cytokines were found in PDR compared with DME and controls, including the novel finding of elevated ADAM11. As such, office-based aspiration is a safe and effective means to identify vitreous factors associated with vitreoretinal disease.

Current and future management of diabetic retinopathy: a personalized evidence-based approach.

Diabetic retinopathy (DR) is the leading cause of new-onset blindness in working-age individuals in the USA and represents a growing worldwide epidemic. Classic risk factors for onset or progression of DR include poor glycemic control, hypertension and hyperlipidemia; however, these factors account for only a small proportion of the risk of DR. New systemic risk factors are emerging, which may allow for personalized risk profiling and targeted treatment by physicians. In addition, early studies of vitreous fluid in patients with DR have resulted in a new paradigm: diabetes causes inflammation in the retina, which is mediated by multiple small signaling molecules that induce angiogenesis and vascular permeability. Future treatment of DR may involve two approaches: early vitreous analysis, followed by drug treatment targeted to the unique vitreous composition of the patient; and collaboration between ophthalmologists and primary care providers to address the unique systemic risk profile of each diabetic patient.

Anterior segment optical coherence tomography versus ultrasound pachymetry to measure corneal thickness in endothelial keratoplasty donor corneas.

PURPOSE: To analyze corneal thickness (CT) by anterior segment optical coherence tomography and ultrasound pachymetry in precut endothelial keratoplasty (EK) donor corneas at the eye bank. METHODS: Thirty-six corneas were analyzed. All corneas were dissected to create lamellar grafts for EK using the standard eye bank protocol. We measured central and peripheral (3 mm from center) CT by ultrasound after lamellar tissue processing and by optical coherence tomography after the tissue was transferred to a viewing chamber. We performed paired t tests and Pearson correlation analyses to compare ultrasound and optical coherence tomography measurements. RESULTS: Central CT measurements by optical coherence tomography versus ultrasound in donor corneas were not statistically different (mean: 169 vs. 177 µm, respectively, P = 0.09). There was a strong correlation between measurements of central CT (r = 0.73, P < 0.0001). There was a statistically significant difference in mean peripheral CT measurements by optical coherence tomography and ultrasound (mean: 190 vs. 236 µm, respectively, P < 0.0001); at peripheral locations, measurements correlated moderately (r = 0.52, P = 0.002). CONCLUSIONS: Optical coherence tomography measurements of EK-prepared tissue averaged 8 µm thinner than the ultrasound measurements, similar to clinical measurements of central CT. Given the growing interest in the effect of EK graft thickness on patient outcomes, it is important to understand the differences in measurements obtained by different devices used to assess donor corneas.

Diabetic retinopathy: An update on treatment.

Diabetic retinopathy is a progressive disease that results from vascular injury due to chronic hyperglycemia. It is the leading cause of blindness in working-age adults in the US and is usually asymptomatic until late stages. Treatment with laser photocoagulation is effective at preventing severe vision loss; thus, diabetic patients should be referred for regular screening by an ophthalmologist. New inhibitors of vascular endothelial growth factor may provide targeted nonsurgical treatment to improve vision in diabetic retinopathy.