Prediction of Proliferative Vitreoretinopathy after Retinal Detachment Surgery: Potential of Biomarker Profiling
Spring 2012
[published online ahead of print April 30, 2012]. Ricker LJAG, Kessels AGH, De Jager W, Hendrikse F, Kijlstra A, la Heij EC. Am J Ophthalmol. 2012;154(2):347-354.e2.
Proliferative vitreoretinopathy (PVR) remains the most common reason for redetachment after retinal detachment repair. As new prophylactic therapies emerge to prevent PVR formation, high-risk subgroups need to be identified to improve the risk-to-benefit ratio of adjunctive treatments. Various cytokines have been implicated in contributing to the development of PVR. This study attempts to evaluate the potential for biomarker profiling in identifying this specific subgroup.
This retrospective case-controlled study evaluated undiluted subretinal fluid samples collected from scleral buckle surgeries for primary rhegmatogenous retinal detachment repairs. These detachments had a maximum PVR grade of C1 and greater than 1 quadrant involvement. Of the 306 samples collected, 45 patients redetached secondary to PVR.
Twenty-four samples were excluded because of low sample volume or contamination (9), late-developing PVR (6), preoperative vitreous hemorrhage (4), preoperative trauma (4), or preoperative cryotherapy (1).
Twenty-one samples were compared with control samples from patients who did not redetach. On average, 86% had macula-off detachments, 81% had intraocular gas injections, 71% had intraoperative cryotherapy, and 33% were pseudophakic.
Multiplex immunoassays (Luminex; Austin, Texas) were used. These contained antibody-coated microspheres incubated with subretinal fluid along with the 50 potential biomarkers of interest.
The biomarkers of interest included various interleukins (ILs), growth factors, chemokines, adhesion molecules, adipokines, proteases, and inhibitors. Researchers analyzed the correlation between concentrations of biomarkers and clinical preoperative and intraoperative risk factors for PVR.
Eighteen biomarkers were shown to be significantly different between the PVR group and case controls. The markers included IL-1a, IL-2, IL-3, IL-6, IL-11, macrophage migration inhibitory factor (MIF), chemokine (C-C motif) ligand 2, CCL3, CCL11, CCL17, CCL18, CCL19, CCL22, chemokine (C-X-C motif) ligand 10, cathepsin S, adiponectin, and intercellular adhesion molecule-1.
The only clinical variable that was an independent predictor of postoperative PVR development was preoperative PVR. The combination of 3 biomarkers: CCL22, IL-3, and MIF in conjunction with preoperative PVR was the best predictor for postoperative PVR redetachment.
The model was able to predict the outcome for PVR redetachment in 94% of cases, with a sensitivity of 94.1% and specificity of 94.2%.
Financial disclosures
Dr. Altaweel – NATIONAL EYE INSTITUTE: Investigator, Grants; GLAXOSMITHKLINE: Investigator, Grants; PFIZER, INC: Investigator, Grants; REGENERON PHARMACEUTICALS, INC: Investigator, Grants.
Dr. Tewari – SYNERGETICS USA: Consultant, Honoraria.
Dr. Kim – None.