Publication: Yırtıklı retina dekolmanı olgularında subretinal sıvıda hücresel adezyon molekülleri: Vasküler hücre adezyon molekülü-1 (VCAM-1) ve L-selektin
Abstract
Yırtıklı retina dekolmanından sonra gelişen proliferatif vitreoretinopati (PVR), dekolman cerrahisinin başarısız olmasına yol açan nedenlerin başında yer alır. PVR'da görülen şiddetli hücresel proliferasyonun gelişiminde immün ve enflamatuvar yanıtın rolü olduğu bilinmektedir. Bu çalışmada, yırtıklı retina dekolmanı olan hastaların subretinal sıvılarında hücresel adezyon moleküllerinden olan VCAM-1 (vasküler hücresel adezyon molekülü) ve L-selektinin (lökosit adezyon molekülü) solubl formları ve bunların PVR şiddeti, dekolman süresi ve dekolman sahasıyla olan ilişkileri araştırılmıştır. Çalışmaya, yırtıklı retina dekolmanı nedeniyle opere edilen ve subretinal sıvı drenajı yapılan 27 olgu dahil edilmiştir. ELISA testi ile bu olguların subretinal sıvılarındaki sVCAM-1 (solubl VCAM-1) ve sL-selektin (solubl L-selektin) düzeyleri incelenmiştir. Subretinal sıvıdaki sVCAM-1 ve sL- selektin düzeylerinin Evre C PVR'lı olgularda ve 8 haftadan daha uzun süreli dekolmanlarda daha yüksek olduğu saptanmıştır. sVCAM-1 düzeyleri dekolman sahasına göre karşılaştırıldığında gruplar arasında anlamlı bir fark görülmezken, dekolman sahası 4 kadranı tutan olgulardaki sL- selektin değerlerinin dekolman sahası 2 kadranı tutan olgulardan yüksek olduğu tespit edilmiştir. Subretinal sıvıda bu hücresel adezyon moleküllerinin saptanması, yırtıklı retina dekolmanı sonrasında gelişen enflamatuvar yanıtın başlangıç evresini göstermesi açısından önem taşımaktadır. Bu çalışmanın, yırtıklı retina dekolmanından sonra PVR oluşumunu engelleyecek medikal tedavilerin geliştirilmesine ışık tutacağı düşünülmektedir.
Purpose: Proliferative vitreoretinopathy (PVR) is the leading cause of failure in rhegmatogenous retinal detachment surgery. Several lines of evidence support the role of inflammatory and immunologic phenomenon in the pathogenesis of PVR. In this study we investigated tha presence of two cell adhesion molecules, soluble VCAM-1 and soluble L-selectin, in subretinal fluids (SRF) of patients suffering from rhegmatogenous retinal detachment and their relationship between the severity of PVR, the duration of retinal detachment and the extent of detachment. Method: Subretinal fluids were collected from 27 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy or uncomplicated retinal detachment. Levels of sVCAM-1 and sL-selectin were quantified with ELISA. Results: The levels of sVCAM-1 and sL-selectin were found to be higher in patients with Grade C PVR and in the detachments lasting longer than 8 weeks of duration. While no significant difference was detected between groups when sVCAM-1 concentrations were compared according to the duration of detachment, the levels of sL-selectin were significantly higher in the detachments extending to 4 quadrants of the retina than those extending to 2 quadrants. Conclusion: The present study supports growing evidence that these cell adhesion molecules are involved in the inflammatory process during the development and progression of PVR. Further understanding of the mechanisms that initiate and control the inflammatory response may have important pathogenetic and therapeutic implications in PVR.
Purpose: Proliferative vitreoretinopathy (PVR) is the leading cause of failure in rhegmatogenous retinal detachment surgery. Several lines of evidence support the role of inflammatory and immunologic phenomenon in the pathogenesis of PVR. In this study we investigated tha presence of two cell adhesion molecules, soluble VCAM-1 and soluble L-selectin, in subretinal fluids (SRF) of patients suffering from rhegmatogenous retinal detachment and their relationship between the severity of PVR, the duration of retinal detachment and the extent of detachment. Method: Subretinal fluids were collected from 27 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy or uncomplicated retinal detachment. Levels of sVCAM-1 and sL-selectin were quantified with ELISA. Results: The levels of sVCAM-1 and sL-selectin were found to be higher in patients with Grade C PVR and in the detachments lasting longer than 8 weeks of duration. While no significant difference was detected between groups when sVCAM-1 concentrations were compared according to the duration of detachment, the levels of sL-selectin were significantly higher in the detachments extending to 4 quadrants of the retina than those extending to 2 quadrants. Conclusion: The present study supports growing evidence that these cell adhesion molecules are involved in the inflammatory process during the development and progression of PVR. Further understanding of the mechanisms that initiate and control the inflammatory response may have important pathogenetic and therapeutic implications in PVR.