Hubungan Kadar TNF-Α dalam Air Mata dengan Retinopati Diabetik pada Pasien Diabetes Mellitus Tipe 2 di Rumah Sakit Prof Chairudin P. Lubis Universitas Sumatera Utara

Abstract

Background: Diabetic retinopathy (DR) is characterized by retinal vascular damage due to diabetes mellitus (DM). DR is one of the microvascular complication from DM that caused visual impairment in adults with DM. Chronic hyperglicemia can disrupt the retinal metabolism and hemodynamic, such as blood flow disruption, vascular permeability elevation, microvascular cells death, and retinal ischemia. Retinal vascular endothelial cells apoptosis is also mediated by inflammation. TNF-alfa are inflammatory cytokine that strongly correlated with insulin resistance and chronic inflammation. In DR, TNF-alfa mediates the apoptosis of retinal neuron and vascular endothelium. Increase of serum TNF-alfa in DR patients was proven by many previous studies, however study regarding TNF-alfa concentration in tear fluids was rarely performed. Objective: To determine the relationship between tear TNF-α concentration and diabetic retinopathy in DM type 2 patients in Prof CPL USU Hospital. Method: This study used observational analytic study with cross sectional design using 40 subjects in USU hospital outpatient clinic. The study started from May 2024 until number of subjects was fulfilled. Subjects was divided into 4 groups, control, DM without DR, NPDR, and PDR. Result: Level of tear TNF-alfa in control group was 0,88 pg/mL and was the lowest mean of TNF-alfa out of all other groups. In DM without DR group, mean tear TNF-alfa was 2,05 pg/mL. In NPDR group, mean TNF-alfa was 2,87 pg/mL. Lastly, the PDR group displayed the highest mean of TNF-alfa, which was 18,65 pg/mL. Oneway Anova test revealed a statistically significant relationship between tear TNF-alfa concentration and retinopathy diabetic. Conclusion: There is a significant differences of tear TNF-alpha between control and diabetic retinopathy group.