HUBUNGAN KADAR INTERLEUKIN 6 (IL-6) PADA AIR MATA DENGAN DERAJAT INFLAMASI PASCA PHOTOREFRACTIVE KERATECTOMY (PRK)

DEDE NENI HERANI, Prof. dr. Suhardjo, SU, Sp.M(K); dr. Angela Nurini Agni, Sp. M (KVR), M.Kes; Jajah Fachiroh, S.P., M.Si, Ph.D

2016 | Tesis-Spesialis | SP ILMU PENYAKIT MATA

Latar Belakang. Photorefractive keratectomy (PRK) telah terbukti efektif sebagai terapi bedah refraktif dalam mengatasi miopia, hiperopia, dan astigmatisma tetapi memiliki kelemahan berupa terjadinya inflamasi pasca operasi yang lebih berat dibandingkan metode bedah refraktif lain. Proses inflamasi merupakan rangkaian penyembuhan luka yang dipengaruhi berbagai faktor diantaranya sitokin. Interleukin 6 (IL-6) adalah suatu sitokin proinflamasi. Peran IL-6 sebagai biomarker berat ringannya inflamasi pasca bedah PRK layak diteliti. Metode. Penelitian menggunakan metode kasus kontrol. Subyek adalah penderita miopia yang menjalani terapi PRK di Jogja LASIK Center RS Mata dr. Yap Yogyakarta (N=36). Sampel air mata dikumpulkan dengan kertas saring. Derajat inflamasi (ringan dan berat) ditentukan melalui follow up hari pertama dan ketujuh pasca PRK dengan menggunakan parameter inflamasi berupa: nyeri (Visual Analogue Scale), blefarospasme, hiperemia limbal, dan lakrimasi. Kadar IL-6 diperiksa dengan ELISA (Enzymed linked immunosorbent assay) di Laboratorium Biologi Molekuler Fakultas Kedokteran UGM. Perbedaan kadar IL- 6 pre dan pasca operasei pada kelompok inflamasi ringan dan berat ditentukan dengan independent t-test. Nilai cut off IL-6 pra operasi ditentukan dari quartil 25% IL-6 yang terukur. Hubungan antara kadar IL-6 pra operasi dengan derajat inflamasi pasca PRK ditentukan dengan Chi square dan nilai P<=0.05 dianggap bermakna. Hasi. Uji normalitas menunjukan data terdistribusi merata (p=0,27). Kedua kelompok (ringan dan berat, masing-masing 18 subyek) sebanding dalam hal demografi dan karakteristik klinik (p>0,05). Nilai cut off adalah 2,7426 pg/ml. Pasca PRK didapatkan peningkatan kadar IL-6 yang bermakna pada kedua kelompok (inflamasi ringan p=0,001, inflamasi berat p=0,006). Subyek dengan kadar IL-6 praoperasi rendah(28 subyek) mengalami inflamasi ringan (11/28) dan berat (17/28) demikian pula subyek dengan kadar IL-6 tinggi (8 subyek); mengalami inflamasi ringan (7/8) dan berat (1/8). OR (Odds Ratio) 0.092 (p=0.016, CI 0.10-0.858). Kesimpulan. Terdapat perbedaan peningkatan kadar IL-6 yang signifikan pada kelompok inflamasi ringan dibandingkan dengan kelompok inflamasi berat. Tidak terdapat perubahan risiko peningkatan IL-6 terhadap derajat inflamasi pasca PRK. Kadar IL-6 pre operasi yang tinggi memiliki risiko 0.09x untuk mengalami inflamasi berat pasca PRK. Penelitian selanjutnya diperlukan untuk mengevaluasi peran IL-6 sebagai biomarker keparahan inflamasi pasca PRK.

Background. Photorefractive keratectomy (PRK) is an effective refractive surgery to cure myopia, hyperopia, and astigmatism that is applicable for many conditions; however, this approach showed more severe post surgery inflammation compared to others. Post PRK inflammation is wound healing process. Interleukin 6 (IL-6) is a major inflammatory cytokine; therefore it is worth explored as biomarker for inflammation severity. Methods. It is a case control study. Subjects were myopia patients whose underwent PRK at Jogja LASIK Center, dr Yap Eye Hospital, Yogyakarta (N=36). Tears were collected using filter paper. Determination of post PRK inflammation severity (mild and severe) was done by using inflammation clinical parameters including pain (Visual Analogue Scale), blepharospasm, limbal hiperemia, and lacrimation. The titer of IL-6 was examined by using ELISA (enzyme linked immunosorbent assay) at Molecular Bology Laboratory, Faculty of Medicine, UGM. The difference of IL-6 titer in pre and post PRK surgery inflammation between mild and severe group was determined by independent ttest. The IL-6 cut off was determined from 25% quarter value of pre surgery Il-6 titer. The association between severity of post surgery inflammation and IL-6 titer was determined by Chi square test. Pvalue p<=0.05 is significant. Result. Two groups of mild and severe inflammation (18 subjects each) showed an equal distribution in demographic and clinical characteristics (p>0.05). The Il- 6 cut off was determined at 2.7426 pg/ml. Post PRK IL-6 titer were significantly elevated in both groups (mild inflammation p=0.001; severe inflammation p=0.006). Pre surgical subjects with low IL-6 (28 sbjects) became either mild (11/28) or severe inflammation (17/28) so does subjects with high IL-6 (8 subjects) became mild (7/8) or severe inflammation (1/8). OR (Odds Ratio) 0.092 (p=0.016, CI 0.10-0.858). Conclusion. Significant difference of IL-6 in pre-post surgical in mild vs severe inflammation group was observed (mean +- SD of 2.84+-3.13 vs 47.31+-62.22, p=.005). Subjects with high pre surgical IL-6 titer has 0.09x risk to have severe post-PRK inflammation.

Kata Kunci : Photorefractive Keratectomy (PRK), proses inflamasi, air mata, ELISA, IL-6