AQUEOUS HUMOR CYTOKINES AND THERAPEUTIC CUSTOMIZATION IN NONRESPONDING MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION.

AIM: To report an alternative cytokine-based customized therapeutic approach of macular edema secondary to retinal vein occlusion.

METHODS: A 64-year-old male patient presented with left eye macular edema secondary to central retinal vein occlusion, status after three consecutive anti-vascular endothelial growth factor injections. He was subsequently subjected to aqueous humor cytokine analysis. Vascular endothelial growth factor, interleukin-6 (IL-6), and interleukin-8 (IL-8) concentrations were determined using multiplex bead assay (BD Cytometric Bead Array). Based on the results, intravitreal steroid was administered. Follow-up examination included monitoring corrected distance visual acuity using Snellen's chart, central subfoveal thickness measurement on spectral domain optical coherence tomography (Spectralis, HRA2; Heidelberg engineering, Heidelberg, Germany) and cytokine quantification at the end of one and three months.

RESULTS: Baseline corrected distance visual acuity was counting fingers at 1 m, which subsequently improved to 6/12 Snellen equivalent 1 month after customized intravitreal therapy. Central subfoveal thickness demonstrated significant reduction from 529 to 253 µm; baseline vascular endothelial growth factor, IL-6, and IL-8 concentration were ascertained to be 29.94, 1.31, and 82.12 pg/mL (picograms/millilitre). One month after intravitreal steroid injection, the IL-8 levels normalized to 13.28 pg/mL. Functional and anatomical improvements were sustained till the last follow-up at 3 months.

CONCLUSION: Customized intravitreal treatment provides an objective, alternative, and effective therapeutic approach for macular edema secondary to retinal vein occlusion.