Publications & Posters

Aqueous Humor Cytokines and Long-Term Response to Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema.


Felfeli T, Juncal VR, Hillier RJ, Mak MY, Wong DT, Berger AR, Kohly RP, Kertes PJ, Eng K, Boyd SR, Altomare F, Giavedoni LR and Muni RH.

Am J Ophthalmol. 2019 Apr 5. pii: S0002-9394(19)30151-5.

DOI: 10.1016/j.ajo.2019.04.002



To determine the association of aqueous humor cytokine concentrations with long-term treatment response to anti-vascularendothelial growth factor (VEGF) agents in diabetic macular edema (DME).


Retrospective case series.


Pooled data of aqueous humor cytokine concentrations collected at baseline and 2-month follow-up (2 injections) for treatment-naïve eyes with center-involving DME previously enrolled in a prospective study were reviewed. Subjects receiving intravitreal anti-VEGF injections outside of study protocol as per standard of care were classified into Responders versus Non-responders based on qualitative assessment of optical coherence tomography for persistence of DME at longitudinal follow-up visits.


Of the 41 eyes, 85% were classified as Responders with a significant decline in baseline central subfield thickness and macularvolume (p’s < 0.001), and 15% were identified as Non-responders to anti-VEGF therapy over 51.4±18.7 months of follow-up. No significant difference in baseline aqueous humor VEGF concentration was noted, while at 2-month follow-up, the Non-responder group had a significantly higher VEGF concentration compared to the Responder group (451.5±690.9pg/ml versus 113.7±211.4pg/ml; p = 0.02). The Responder group also demonstrated a significant decline from baseline to 2-month follow-up in concentration of intercellular adhesion molecule-1 (p < 0.001), interleukin-10 (p = 0.041), monocyte chemotactic protein-1 (p = 0.046), placental growth factor (p = 0.027), and transforming growth factor-β2 (p = 0.017).


Aqueous humor cytokine concentrations serve as an early biomarker for long-term response to anti-VEGF therapy, and may enable more effective treatment regimens that improve anatomical outcomes in eyes with DME.