Topical Interferon Alpha 2b in the Treatment of Refractory Diabetic Macular Edema
Purpose: To report the efficacy of topical interferon alpha 2b in the treatment of refractory diabetic macular edema.
Methods: In this retrospective interventional case series, five eyes of three individuals with diabetic macular edema resistant to multiple intravitreal injections of anti-vascular endothelial growth factor drugs and macular photocoagulation were included.
Results: All studied eyes had undergone multiple intravitreal injections including bevacizumab, combination of bevacizumab and triamcinolone and aflibercept, and macular laser photocoagulation before being included in this study. Two intravitreal ranibizumab injections had also been performed in both eyes of one patient. Two eyes had undergone pars plana vitrectomy, one for diabetic macular edema and the other for rhegmatogenous retinal detachment. After a discussion regarding the experimental topical interferon alpha 2b treatment, all patients agreed to start interferon alpha 2b drops four times a day. One month after the treatment, optical coherence tomography demonstrated a significant improvement in macular structure and thickness which was stable or improved at the three-month follow-up visit. Visual acuity in all eyes was stable or improved throughout the three-month follow-up period. Conjunctival injection and follicular conjunctivitis were the side effects of topical interferon alpha 2b and were treated with lubrication and steroids.
Conclusion: This case series demonstrated the potential efficacy of interferon alpha 2b in the treatment of refractory diabetic macular edema. It might be an option in patients with contraindications for intravitreal injections.
Diabetic Macular Edema, Interferon α2b
1. Browning DJ, Stewart MW, Lee C. Diabetic macular edema: evidence-based management. Indian J Ophthalmol. 2018;66:1736–1750.
2. Xie XW, Xu L, Wang YX, Jonas JB. Prevalence and associated factors of diabetic retinopathy. The Beijing eye study 2006. Graefes Arch Clin Exp Ophthalmol 2008;246:1519–1526.
3. Rubino A, Rousculp MD, Davis K, Wang J, Girach A. Diagnosed diabetic retinopathy in France, Italy, Spain, and the United Kingdom. Prim Care Diabetes 2007;1:75–80.
4. Wong TY, Klein R, Islam FM, Cotch MF, Folsom AR, Klein BE, et al. Diabetic retinopathy in a multi-ethnic cohort in the United States. Am J Ophthalmol 2006;141:446–455.
5. Varma R, Torres M, Peña F, Klein R, Azen SP, Los Angeles Latino Eye Study Group. Prevalence of diabetic retinopathy in adult Latinos: The Los Angeles Latino eye study. Ophthalmology 2004;111:1298–1306.
6. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556–564.
7. Urias EA, Urias GA, Monickaraj F, McGuire P, Das A. Novel therapeutic targets in diabetic macular edema: Beyond VEGF. Vision Res. 2017;139:221–227.
8. Adamis AP, Berman AJ. Immunological mechanisms in the pathogenesis of diabetic retinopathy. Semin Immunopathol 2008;30:65–84.
9. Moisseiev E, Loewenstein A. Diabetic macular edema: emerging strategies and treatment algorithms. Dev Ophthalmol 2017;60:165–174.
10. George PM, Badiger R, Alazawi W, Foster GR, Mitchel JA. Pharmacology and therapeutic potential of interferons. Pharmacol Ther 2012;135:44–53.
11. Gillies MC, Su T. Interferon-alpha 2b enhances barrier function of bovine retinal microvascular endothelium in vitro. Microvasc Res 1995;49:277–288.
12. Maleki A, Meese H, Sahawneh H, Foster CS. Prognosis in the understanding and utilization of biologic response modifiers in the treatment of uveitis. Expert Rev Clin Immunol 2016;12:775–786.
13. Maleki A, Aghaei H, Lee S. Topical interferon alpha 2b in the treatment of refractory pseudophakic cystoid macular edema. Am J Ophthalmol Case Rep 2018;10:203–205.
14. Cellini M, Balducci N, Strobbe E, Campos EC. Subtenon injection of natural leukocyte interferon α-2a in diabetic macular edema: a case report. BMC Ophthalmol 2013;13:63.
15. Vujosevic S, Simó R. local and systemic inflammatory biomarkers of diabetic retinopathy: an integrative approach. Invest Ophthalmol Vis Sci 2017;58:BIO68– BIO75.
16. Sfikakis PP, Grigoropoulos V, Emfietzoglou I, Theodossiadis G, Tentolouris N, Delicha E, et al. Infliximab for diabetic macular edema refractory to laser photocoagulation: a randomized, double-blind, placebo-controlled, crossover, 32-week study. Diabetes Care 2010;33:1523–1528.
17. Lincoff H, Stanga P, Movshovich A, Palleroni A, Madjarov B, Rivera R, et al. Choroidal concentration of interferon after retrobulber injection. Invest Ophthalmol Vis Sci 1996;37:2768–2771.