DYNAMICS OF INTERCELLULAR ADHESION MOLECULE-1 (ICAM-1) IN PATIENTS WITH DIABETIC NEOVASCULAR GLAUCOMA

Abstract

Cyclophotocoagulation (CPC) is the most widely used treatment method for neovascular glaucoma (NVG). We hypothesized that significant inflammation in patients with diabetic NVG would predict poorer СРС outcomes. Methods. 70 diabetes patients (75 cases) with painful NVG aged from 31 to 75 years were treated (pain syndrome was in 100% of cases; HbA1 was 7.8±0.98 %; type I diabetes was in 22 (29%) patients). The best corrected visual acuity (BCVA) before treatment was 0.06±0.1. IOP - 36.2±4.52 mmHg, with maximum antihypertensive therapy (2.44±5.37 drugs). A course of treatment with a diode laser (λ=810 nm, P=0.9-1.3 W, t=2 s) was carried out in all cases. 54 patients underwent infrared (940 nm) diaphanoscopy with transpalpebral illumination. After the course of CPC, patients were prescribed topical dexamethasone drops without preservatives in unit doses (1 month), taking into account the expression of the inflammatory cytokine ICAM-1 on peripheral blood lymphocytes. The CPC was repeated at IOP ≥ 28 mm Hg. A new success was at IOP ≤ 21 mm Hg. Results. A course of CPC relieved pain in 100% of patients. After 3 months, IOP was 24.3±6.88 mmHg, so a repeat course of treatment was carried out in 40% of eyes. IOP in these patients decreased by 30% to 22.9±4.16 mmHg. Panretinal photocoagulation (PRP) of the retina – 39% of eyes. After 12 months, IOP decreased by 46% from the initial level (to 19.5±3.22 mmHg, p=0.000), and complete success was achieved in 81.3% of cases. BCVA after treatment was 0.08±0.12. Patients who did not fully respond to the first CPC (30 eyes) and required additional laser procedure, had high expression values of the ICAM-1 (609.0 cells/μL). The need for a second course of CPC had a probable (p<0.05) relationship with baseline HbA1 data (rs=0.85), duration of diabetes (rs=0.6), IOP (rs=0.65), ICAM-1 (rs=0.65), PRP (rs=0.28). Conclusions. Repeated cyclophotocoagulation in patients with painful diabetic neovascular glaucoma is safe, effectively relieves pain, significantly reduces intraocular pressure (up to 19.5 mm Hg), and minimizes the risk of complications in the long-term follow-up period. Long-term local anti-inflammatory treatment in patients with high initial values of ICAM-1 expression in peripheral blood lymphocytes increases the effectiveness of procedures (in 81.3% of cases) for 12 months.