Vascular Endothelial Growth Factor in Anterior Chamber Liquid Patients with Diabetic Retinopathy, Cataract and Neovascular Glaucoma

Abstract

IntroductionThe aims of this study were: (1) to investigate the association of vascular endothelial growth factor isoform A (VEGF-A) concentration in the anterior chamber liquid (ACL) with vascular proliferation in patients with diabetic retinopathy (DR) who had undergone surgical treatment for cataract and neovascular glaucoma; (2) to analyze the association of VEGF-A level in ACL with the cataract surgery outcomes.Materials and MethodsUndiluted aqueous fluid samples were obtained from 207 eyes of patients who underwent intraocular surgery, 136 patients with diabetes mellitus (DM) and 22 patients without DM. The ACL samples were obtained during operation. The VEGF-A levels were analyzed by enzyme-linked immunosorbent assay.ResultsThe lowest VEGF-A levels were in diabetic patients without signs of DR [22.75 pg/mL (10.78; 63.36)]. More severe DR tended to occur in diabetic patients with higher VEGF-A levels in ACL. In diabetic patients with proliferative DR (PDR), VEGF-A levels were significantly higher [336.6 pg/mL (232.3; 410.74)] than in patients without DR P < 0.0001. In patients with terminal stage of DR [neovascular glaucoma (NG)], VEGF-A levels were dramatically higher and attained 1,634.01 pg/mL (610.69; 2657.33). In non-diabetic patients, VEGF-A levels were 95.07 pg/ml (60.92; 129.22). The best visual acuity results in post-operative period were observed in the group of diabetic patients without DR. In the group of patients with PDR, post-operative visual acuity [0.26 (0.1; 0.42)] was similar to visual acuity before operation [0.29 (0.13; 0.44)]. There was no significant increase in visual acuity due to cataract surgery. In 52.4% patients, no complications had occurred by the end of the follow-up period. In 40% patients, retinal laser coagulation was performed, and in 7.6% patients NG had developed.ConclusionVEGF-A level in ACL increases with DR progression and may be of prognostic value in evaluating the potential risk of further neovascularization progression in diabetic patients.

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“…51,59,130 In addition, the aqueous and vitreous levels of VEGF are higher in patients with NVG associated with diabetes than in diabetic patients with only proliferative retinopathy. 66 These results confirm the importance of VEGF signaling in neovascularization in NVG. Therefore, the use of VEGF inhibitors to reduce VEGF levels has been explored as a treatment option for NVG, and multiple case series have indicated the treatment efficacy of anti-VEGF agents, predominantly intravitreal injections of bevacizumab and ranibizumab, in reducing neovascularization in the iris and angle in NVG.…”

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“…[ 10 11 ] VEGF concentration in NVG patients is elevated in both the aqueous humor and vitreous humor, which shows ischemic severity. [ 12 13 ] As VEGF is a key modulator in the angiogenic cascade, its additional inhibition has been recently proposed as a therapeutic option in the treatment of various diseases including NVG. [ 14 15 ] Ranibizumab is a fully humanized murine monoclonal antibody fragment, much smaller than the parent molecule and affinity purified to provide stronger binding and inhibition of a number of isoforms of VEGF-A.…”

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“…In patients with NVG as a result of PDR, Kuzmin et al [9] showed that the VEGF level in aqueous humor was significantly higher than in the control group. The level of aqueous VEGF determines the failure of Ahmed valve implantation among patients with NVG brought about by PDR.…”