Aqueous flare as a marker of retinal disease activity after anti‐VEGF injections
2018; Wiley; Volume: 96; Issue: 8 Linguagem: Inglês
10.1111/aos.13821
ISSN1755-3768
AutoresClaudia Taipale, Juha‐Matti Lindholm, Raimo Tuuminen,
Tópico(s)Ocular Diseases and Behçet’s Syndrome
ResumoActa OphthalmologicaVolume 96, Issue 8 p. e1043-e1044 Letter to the EditorFree Access Aqueous flare as a marker of retinal disease activity after anti-VEGF injections Claudia Taipale, Claudia Taipale orcid.org/0000-0001-9424-8872 Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland Department of Ophthalmology, Helsinki University Hospital, Helsinki, FinlandSearch for more papers by this authorJuha-Matti Lindholm, Juha-Matti Lindholm orcid.org/0000-0003-4371-9456 Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland Department of Ophthalmology, Helsinki University Hospital, Helsinki, FinlandSearch for more papers by this authorRaimo Tuuminen, Corresponding Author Raimo Tuuminen raimo.tuuminen@helsinki.fi orcid.org/0000-0003-1550-8125 Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotka, Finland Correspondence: Raimo Tuuminen, MD, PhD, FEBO Helsinki Retina Research Group University of Helsinki Haartmaninkatu 3 P.O. Box 21, FI00014 Helsinki, Finland Fax: +358 9 2411227 Email:raimo.tuuminen@helsinki.fiSearch for more papers by this author Claudia Taipale, Claudia Taipale orcid.org/0000-0001-9424-8872 Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland Department of Ophthalmology, Helsinki University Hospital, Helsinki, FinlandSearch for more papers by this authorJuha-Matti Lindholm, Juha-Matti Lindholm orcid.org/0000-0003-4371-9456 Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland Department of Ophthalmology, Helsinki University Hospital, Helsinki, FinlandSearch for more papers by this authorRaimo Tuuminen, Corresponding Author Raimo Tuuminen raimo.tuuminen@helsinki.fi orcid.org/0000-0003-1550-8125 Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotka, Finland Correspondence: Raimo Tuuminen, MD, PhD, FEBO Helsinki Retina Research Group University of Helsinki Haartmaninkatu 3 P.O. Box 21, FI00014 Helsinki, Finland Fax: +358 9 2411227 Email:raimo.tuuminen@helsinki.fiSearch for more papers by this author First published: 23 September 2018 https://doi.org/10.1111/aos.13821Citations: 3AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Editor, Aqueous flare is a good indicator of an intraocular inflammatory process and it can be reliably measured with laser flare photometry (Tugal-Tutkun et al. 2008; Noma et al. 2013). Flare values have been shown to alternate according to changes in the blood–retina barrier (BRB) integrity in retinal diseases (Noma et al. 2013; Hautamaki et al. 2016) and they correlate well with the amount of leakage in fluorescein angiography (Tugal-Tutkun et al. 2008). Flare levels increase with advancing wet age-related macular degeneration (wAMD) and higher flare levels may precede the development of the disease. The higher flare level correlated to the presence of macular oedema in wAMD (Hautamaki et al. 2016) and in central retinal vein occlusion (Noma et al. 2013). Flare levels were also higher in diabetic patients with clinically significant macular oedema compared to those with only nonproliferative diabetic retinopathy and patients without diabetes (Zaczek & Zetterstrom 1998). Some surgical procedures increase flare values and contribute to the breakdown of BRB. A recent study found flare values to be a good surrogate marker for the development of postoperative proliferative vitreoretinopathy (Mulder et al. 2017). Here, we measured aqueous flare in patients with wAMD, diabetic macular oedema (DME), cystoid macular oedema (CME) due to retinal vein occlusion (RVO) and CME related to other retinal disease, including eyes with, for example pseudophakic, myopic and postvitrectomy CME and chronic serous chorioretinopathy. The patients were receiving treatment with antivascular endothelial growth factor injections (anti-VEGF) and analysed according to whether the injections were continued or whether no injections were needed. Aqueous flare values were measured using a laser flare meter (FM-600, Kowa Company, Ltd., Nagoya, Japan) and a mean of five reliable measurements was used in the analysis. Aqueous flare was measured in the beginning of each visit before the injection or the decision to follow without injection. No dilating drops were installed before the measurements. All the measurements were performed by an experienced research technician blinded from the treating physician. The study was conducted by monitoring the clinical practice. To patients with wAMD, anti-VEGF treatment (aflibercept or bevacizumab) was given using the treat-and-extend (TER) protocol (n = 189). The need for retreatment was evaluated before each injection, and the treatment interval was gradually extended up to a maximum of 12 weeks. After successfully reaching the 12-week interval, patients with inactive disease (n = 13) were observed without treatment. In patients with DME (n = 50), RVO (n = 28) and other retinal disease (n = 14), a fixed-PRN protocol was used. Patients were given three monthly anti-VEGF injections and then evaluated 6 weeks after the last injection regardless of the anti-VEGF agent. In the absence of macular oedema, follow-up was organized at the outpatient clinic. Aqueous flare was higher among patient groups during anti-VEGF treatment compared to visits when no treatment was necessary (Table 1). In wAMD patients, flare values were 22.7 ± 35.5 photon units (pu)/ms (mean ± SD) during treatment versus 10.9 ± 5.2 pu/ms when no injection was given (p < 0.001). In DME patients, the values were 19.7 ± 16.6 pu/ms versus 7.1 ± 2.9 pu/ms (p = 0.009), and in patients with other retinal disease 28.7 ± 31.8 pu/ms versus 6.2 ± 2.2 pu/ms (p = 0.021) respectively. Our data suggest that aqueous flare reflects retinal disease activity by decreasing during treatment-free periods. Further studies are still warranted to investigate whether aqueous flare can be used to help estimate optimal follow-up interval and risk of reactivation in patients with anti-VEGF injections for retinal diseases. Table 1. Aqueous flare according to the retinal status in patients with wAMD, DME, CME due to RVO, and CME related to other retinal disease wAMD Anti-VEGF (n = 189) No injection (n = 13) p Gender (M/F) n/% 60:129 (32:68%) 7:6 (54:46%) 0.102 Age (years) 81.4 ± 6.9 (65–95) 82.2 ± 6.1 (69–93) 0.640 Laterality (uni:bilateral) 137:26 (84:16%) 11:1 (92:8) 0.695 Drug (afl:bev) 36:153 (19:81%) - Aqueous flare (pu/ms) 22.7 ± 35.5 (1.1–322.3) 10.9 ± 5.2 (4.7–24.1) <0.001 DME Anti-VEGF (n = 50) No injection (n = 2) p Gender (M/F) n/% 28:22 (56:44%) 0:2 (0:100%) 0.208 Age (years) 66.5 ± 8.0 (53–83) 48.0 ± 0.0 (48) <0.001 Laterality (uni:bilateral) 38:6 (86:14%) 0:1 (0:100%) 0.156 Drug (afl:bev) 7:43 (14:86%) - Aqueous flare (pu/ms) 19.7 ± 16.6 (4.9–101.2) 7.1 ± 2.9 (5.0–9.1) 0.009 RVO Anti-VEGF (n = 28) No injection (n = 1) p Gender (M/F) n/% 15:13 (54:46%) 0:1 Age (years) 76.7 ± 12.0 (50–93) 76 Laterality (uni:bilateral) 26:1 (96:4%) 1:0 Drug (afl:bev) 2:26 (7:93%) - Aqueous flare (pu/ms) 14.5 ± 12.0 (4.5–63.7) 10.1 Other retinal disease Anti-VEGF (n = 14) No injection (n = 2) p Gender (M/F) n/% 7:7 (50:50%) 2:0 (100:0%) 0.475 Age (years) 75.6 ± 13.4 (35–92) 77.0 ± 0.0 (77) 0.712 Laterality (uni:bilateral) 10:2 (83:17%) 0:1 (0:100%) 0.231 Drug (afl:bev) 0:14 (0:100%) - Aqueous flare (pu/ms) 28.7 ± 31.8 (3.3–115.3) 6.2 ± 2.2 (4.6–7.7) 0.021 Baseline variables regarding (i) patient and (ii) ophthalmic parameters. Data are given as mean (±SD) and range or absolute number and proportion. For two-group comparisons, qualitative data were analysed with the two-factor χ² test (or with the Fisher's exact test when values in any of the cells of a contingency table were below five) and continuous variables with unequal variances t-test (Welch's t-test). Anti-VEGF; anti-vascular endothelial growth factor, afl; aflibercept, bev; bevacizumab, CME; cystoid macular oedema, pu; photon units, DME; diabetic macular oedema, RVO; retinal vein occlusion, wAMD; wet age-related macular degeneration. p ≤ 0.05 was considered statistically significant (Bold). References Hautamaki A, Luoma A & Immonen I (2016): Anterior chamber flare during bevacizumab treatment in eyes with exudative age-related macular degeneration. Retina 36: 2183– 2190. Mulder VC, van Dijk EHC, van Meurs IA, La Heij EC & van Meurs JC (2017): Postoperative aqueous humour flare as a surrogate marker for proliferative vitreoretinopathy development. Acta Ophthalmol 96: 192– 196. 2017 Oct 25. [Epub ahead of print] Noma H, Mimura T, Tatsugawa M & Shimada K (2013): Aqueous flare and inflammatory factors in macular edema with central retinal vein occlusion: a case series. BMC Ophthalmol 13: 78. Tugal-Tutkun I, Cingu K, Kir N, Yeniad B, Urgancioglu M & Gul A (2008): Use of laser flare-cell photometry to quantify intraocular inflammation in patients with Behcet uveitis. Graefes Arch Clin Exp Ophthalmol 246: 1169– 1177. Zaczek A & Zetterstrom C (1998): Aqueous flare intensity after phacoemulsification in patients with diabetes mellitus. J Cataract Refract Surg 24: 1099– 1104. Citing Literature Volume96, Issue8December 2018Pages e1043-e1044 ReferencesRelatedInformation
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