Pro-permeability Factors in Diabetic Macular Edema; The Diabetic Macular Edema Treated with Ozurdex Trial

Peter A. Campochiaro, Gulnar Hafiz, Tahreem A. Mir, Adrienne W. Scott, Ingrid Zimmer-Galler, Syed M. Shah, Adam S. Wenick, Christopher J. Brady, Ian Han, Lingmin He, Roomasa Channa, David Poon, Catherine Meyerle, Mary Beth Aronow, Akrit Sodhi, James T. Handa, Saleema Kherani, Yong Han, Raafay Sophie, Guohua WangJiang Qian

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose The Diabetic Macular Edema Treated with Ozurdex (DMEO) Trial measured aqueous pro-permeability factors (PPFs) in diabetic macular edema (DME) patients before and after injection of dexamethasone implant or vascular endothelial growth factor (VEGF)-neutralizing protein and correlated changes in levels with changes in excess foveal thickness (EFT) to identify potential PPFs contributing to DME. Design Prospective, randomized crossover clinical trial. Methods Twenty DME patients randomized to dexamethasone implant or VEGF-neutralizing protein had aqueous taps and spectral-domain optical coherence tomography (SDOCT) at baseline and every 4 weeks for 28 weeks. Aqueous levels of 55 vasoactive proteins were measured with protein array. Crossover at week 16 provided changes in protein levels after each intervention in all 20 patients. Results After dexamethasone implant there was significant correlation between changes in levels of 13 vasoactive proteins with changes in EFT, including 3 known PPFs: angiopoietin-2 (r = 0.40, P =.001), hepatocyte growth factor (HGF; r = 0.31, P =.02), and endocrine gland-VEGF (EG-VEGF, r = 0.43, P <.001). Reduction of prolactin, insulin-like growth factor binding protein-3, and matrix metalloproteinase-9 correlated with edema reduction after injection of a VEGF-neutralizing protein as well as dexamethasone implant, suggesting their modulation is likely secondary to changes in edema rather than causative. Conclusions Correlation of edema reduction with reduction in the PPFs angiopoietin-2, HGF, and EG-VEGF provides potential insight into the multifactorial molecular mechanism by which dexamethasone implants reduce edema and suggest that additional study is needed to investigate the contributions of these 3 factors to chronic DME.

Original languageEnglish (US)
Pages (from-to)13-23
Number of pages11
JournalAmerican journal of ophthalmology
Volume168
DOIs
StatePublished - Aug 1 2016

ASJC Scopus subject areas

  • Ophthalmology

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