Abstract:
Introduction. Some patients with diabetic neovascular glaucoma (NVG) do not fully
respond to transscleral (TSC) cyclophotocoagulation (CPC) due to significant
inflammation and insufficient glucose control. Biomarkers of neuroinflammation,
neurodegeneration, and vasculopathy are found in intraocular fluids, and their
concentration changes at different stages of diabetic retinopathy (DR). CD-54 is a
cell surface glycoprotein, expressed on immune, endothelial and epithelial cells, and
induced by various inflammatory cytokines. The involvement of CD-54 as a signalling
cellular receptor in the initiation of inflammatory responses and the resolution of
inflammation is an interesting problem.
Aim of the study to determine the effect of baseline blood levels of intercellular
adhesion molecule-1 (ICAM-1) and glycated haemoglobin (HbA1c) on the
management of patients with diabetic NVG by TSC CPC.
Methods and Materials This open prospective study included 70 diabetic patients
(75 eyes; aged Ме 63.0 years) with painful NVG and 20 healthy individuals (aged Ме
61.5 years) as an immunological control. All patients underwent TSC СPC with a
diode laser. ICAM-1 (CD54) expression in baseline blood samples was determined
on peripheral blood lymphocytes using an immunocytochemical peroxidase-antiperoxidase (PAP) technique and monoclonal antibodies. HbA1c levels were
measured by high-performance liquid chromatography from whole blood in all
patients. Baseline HbA1c levels and ICAM-1 expression in blood samples were
determined. Follow-up was 12 months. Data processing was performed using the
Statistica program (version 10.0, StatSoft Inc., USA).
Results and Conclusions One month after TSC CPC, IOP decreased by 28% compared
to baseline. The effectiveness of laser treatment after 12 months of follow-up was
63% with IOP decrease by 46%. In patients with NVG, the initial level of ICAM-1 was
2,5 times higher than in the control group. Patients who did not fully respond to the
first TSC CPC (30 eyes) and required additional laser procedure, had high initial
HbA1c (9,5%) and high expression values of the ICAM-1 (609,0 cells/μL). Repeated
procedures of TSC CPC at high IOP in diabetic patients with NVG are associated with
high initial values of expression of ICAM-1 in peripheral blood and high HbA1c. The
strategy of management of patients with diabetic NVG should be aimed at intensive
glucose control and local anti-inflammatory treatment.
