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The Relationship of Neutrophil to Lymphocyte Ratio with Vitreomacular Traction Syndrome

Cagri ILHAN, Mehmet CITIRIK, Mehmet Murat UZEL, Kemal TEKIN


This study was conducted to reveal the role of systemic low-grade inflammation by calculating the Neutrophil/Lymphocyte Ratio (NLR) in Vitreomacular Traction Syndrome (VMTS) of different etiologies. A retrospective examination was made of the medical records at a tertiary referral hospital. The study included 31 patients with diabetic VMTS, 27 patients with idiopathic VMTS, and 35 healthy subjects as the control group. The White Blood Cell (WBC) counts and Neutrophil-to-Lymphocyte Ratio (NLR) was compared. There were  insignificant differences between the groups in terms of mean age and female/male ratio (P>0.05). The mean ± Standard Deviation (SD) of NLR was calculated as 2.43 ± 0.83 in the diabetic VMTS group, 2.38 ± 0.96 in the idiopathic VMTS group, and 1.83 ± 0.52 in the control group (P=0.007). The values of the diabetic and idiopathic VMTS groups were significantly higher than those of the control group (P=0.002 and P=0.032, respectively). However, differences between the diabetic and idiopathic VMTS groups were insignificant (P=0.651). This study found significantly higher NLR in patients with diabetic and idiopathic VMTS than the control group. Elevated NLR could therefore be a potential indicator of VMTS, irrespective of the etiology.


Johnson MW. Posterior vitreous detachment: evolution and role in macular disease. Retina. 2012;32 Suppl 2:S174-8. doi: 10.1097/IAE.0b013e31825bef62 pmid: 22929316

Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611-9. doi: 10.1016/j.ophtha.2013.07.042 pmid: 24053995

Bottos J, Elizalde J, Rodrigues EB, Farah M, Maia M. Classifications of vitreomacular traction syndrome: diameter vs morphology. Eye (Lond). 2014;28(9):1107-12. doi: 10.1038/eye.2014.128 pmid: 24993318

Klein R, Klein BE, Wang Q, Moss SE. The epidemiology of epiretinal membranes. Trans Am Ophthalmol Soc. 1994;92:403-25; discussion 25-30. pmid: 7886875

Kurihara T, Noda K, Ishida S, Inoue M. Pars plana vitrectomy with internal limiting membrane removal for macular hole associated with proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2005;243(7):724-6. doi: 10.1007/s00417-004-1081-x pmid: 15657774

Smith T. Pathologic findings after retina surgery. In: Schepens C, editor. Importance of the vitreous body in retina surgery with special emphasis on reoperations. St Louis: Mosby; 1960.

Sertoglu E, Uyanik M. Accurate use of neutrophil/lymphocyte ratio from the perspective of laboratory experts. Vasc Health Risk Manag. 2014;10:13-4. doi: 10.2147/VHRM.S56906 pmid: 24379679

Nunez J, Nunez E, Bodi V, Sanchis J, Minana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol. 2008;101(6):747-52. doi: 10.1016/j.amjcard.2007.11.004 pmid: 18328833

Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995-1002. doi: 10.1016/j.ahj.2007.06.043 pmid: 17967611

Valero C, Pardo L, Lopez M, Garcia J, Camacho M, Quer M, et al. Pretreatment count of peripheral neutrophils, monocytes, and lymphocytes as independent prognostic factor in patients with head and neck cancer. Head Neck. 2017;39(2):219-26. doi: 10.1002/hed.24561 pmid: 27534525

Zhao W, Wu Z, Li Y, Jia H, Chen M, Gu X, et al. Pretreatment neutrophil-to-lymphocyte ratio and its dynamic changes are associated with the overall survival in advanced cancer patients undergoing palliative care. Sci Rep. 2016;6:31394. doi: 10.1038/srep31394 pmid: 27510632

Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218-30. doi: 10.1016/j.critrevonc.2013.03.010 pmid: 23602134

Kaya MG. [Inflammation and coronary artery disease: as a new biomarker neutrophil/lymphocyte ratio]. Turk Kardiyol Dern Ars. 2013;41(3):191-2. doi: 10.5543/tkda.2013.84484 pmid: 23703552

Smiddy WE, Michels RG, Green WR. Morphology, pathology, and surgery of idiopathic vitreoretinal macular disorders. A review. Retina. 1990;10(4):288-96. doi: 10.1097/00006982-199010000-00012 pmid: 2089546

Gandorfer A, Rohleder M, Kampik A. Epiretinal pathology of vitreomacular traction syndrome. Br J Ophthalmol. 2002;86(8):902-9. pmid: 12140213

Takahashi H, Nomura Y, Tan X, Fujino Y, Kawashima H, Yanagi Y. Effects of posterior vitreous detachment on aqueous humour levels of VEGF and inflammatory cytokines. Br J Ophthalmol. 2015;99(8):1065-9. doi: 10.1136/bjophthalmol-2014-306051 pmid: 25722492

Kurtul BE, Ozer PA. The Relationship between Neutrophil-to-lymphocyte Ratio and Age-related Macular Degeneration. Korean J Ophthalmol. 2016;30(5):377-81. doi: 10.3341/kjo.2016.30.5.377 pmid: 27729758

Ozgonul C, Sertoglu E, Mumcuoglu T, Kucukevcilioglu M. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Novel Biomarkers of Primary Open-Angle Glaucoma. J Glaucoma. 2016;25(10):e815-e20. doi: 10.1097/IJG.0000000000000392 pmid: 26918914

Li S, Cao W, Han J, Tang B, Sun X. The diagnostic value of white blood cell, neutrophil, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio in patients with primary angle closure glaucoma. Oncotarget. 2017;8(40):68984-95. doi: 10.18632/oncotarget.16571 pmid: 28978173

Dursun A, Ozturk S, Yucel H, Ozec AV, Dursun FG, Toker MI, et al. Association of neutrophil/lymphocyte ratio and retinal vein occlusion. Eur J Ophthalmol. 2015;25(4):343-6. doi: 10.5301/ejo.5000570 pmid: 25633622

Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ, Offenbacher S, et al. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet. 1999;353(9165):1649-52. doi: 10.1016/s0140-6736(99)01046-6 pmid: 10335783

Pitsavos C, Tampourlou M, Panagiotakos DB, Skoumas Y, Chrysohoou C, Nomikos T, et al. Association Between Low-Grade Systemic Inflammation and Type 2 Diabetes Mellitus Among Men and Women from the ATTICA Study. Rev Diabet Stud. 2007;4(2):98-104. doi: 10.1900/RDS.2007.4.98 pmid: 17823694

Ulu SM, Dogan M, Ahsen A, Altug A, Demir K, Acarturk G, et al. Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes Technol Ther. 2013;15(11):942-7. doi: 10.1089/dia.2013.0097 pmid: 23919588

Theodossiadis GP, Grigoropoulos VG, Theodoropoulou S, Datseris I, Theodossiadis PG. Spontaneous resolution of vitreomacular traction demonstrated by spectral-domain optical coherence tomography. Am J Ophthalmol. 2014;157(4):842-51 e1. doi: 10.1016/j.ajo.2014.01.011 pmid: 24445034

Almeida DR, Chin EK, Rahim K, Folk JC, Russell SR. Factors associated with spontaneous release of vitreomacular traction. Retina. 2015;35(3):492-7. doi: 10.1097/IAE.0000000000000346 pmid: 25207947

Codenotti M, Iuliano L, Fogliato G, Querques G, Bandello F. A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome. Graefes Arch Clin Exp Ophthalmol. 2014;252(11):1729-35. doi: 10.1007/s00417-014-2645-z pmid: 24764038

Stalmans P, Benz MS, Gandorfer A, Kampik A, Girach A, Pakola S, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012;367(7):606-15. doi: 10.1056/NEJMoa1110823 pmid: 22894573

Uzel MM, Citirik M, Ilhan C, Tekin K. Correlation between Central Foveal Thickness and Visual Acuity in Patients with Idiopathic Vitreomacular Traction. Retina. 2018;38(5):907-12. doi: 10.1097/IAE.0000000000001635 pmid: 28338558

Swanson MW, McGwin G, Jr. Anti-inflammatory drug use and age-related macular degeneration. Optom Vis Sci. 2008;85(10):947-50. doi: 10.1097/OPX.0b013e31818883e0 pmid: 18832975

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