Intraocular VEGF Level as a Risk Factor for Postoperative Complications after Vitrectomy for Proliferative Diabetic Retinopathy

Wakabayashi, Yoshihiro; Usui, Yoshihiko; Okunuki, Yoko; Ueda, Shunichiro; Kimura, Kazuhiro; Muramatsu, Daisuke; Kezuka, Takeshi; Gotô, Hiroshi

doi:10.1167/iovs.12-10367

Cited by 52 publications

(67 citation statements)

References 32 publications

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“…This implies the high prognostic value of VEGF-A levels >137.4 pg/mL in evaluating the risk of complications and their onset times. Similar results were reported by Wakabayashi et al [25]. They assessed the vitreous and ACL level of VEGF as a significant risk factor for the early post-operative hemorrhage and NVG development.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 2013

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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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Section: Discussionsupporting

confidence: 87%

“…Moreover, NG due to PDR is associated with extremely high VEGF level. Several authors [22, 23] demonstrated the elevation VEGF value in the glaucomatous eyes and the benefits of the blockage of the VEGF in the eye [24, 25]. In this way, VEGF-A levels in ACL are associated with the severity of DR.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…Funatsu et al [18] previously reported cases in which the retinopathy was aggravated after a vitrectomy and speculated that the levels of intravitreal VEGF and endostatin were involved. Wang et al [19] also demonstrated that there was an association between the VEGF level and the progression of postoperative retinopathy, while Wakabayashi et al [17] reported finding a correlation between postoperative complications and the intravitreal VEGF level.…”

Section: Discussionmentioning

confidence: 99%

“…Following a vitrectomy, it is further anticipated that with higher intravitreal VEGF levels, there will be more frequent postoperative complications and a worse postoperative visual acuity. Although a few studies have reported similar findings, these issues have yet to be sufficiently examined [17,18,19]. Therefore, the present study examined the relationship between the intravitreal VEGF level and the frequency of surgical complications in PDR patients who underwent a vitrectomy.…”

Section: Introductionmentioning

confidence: 87%

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Level of Vascular Endothelial Growth Factor in the Vitreous Fluid of Proliferative Diabetic Retinopathy Patients and Prognosis after Vitrectomy

Suzuki

Kudo

et al. 2016

Ophthalmologica

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Purpose: The aim of this study was to evaluate the relationship between the intravitreal vascular endothelial growth factor (VEGF) level and prognosis of proliferative diabetic retinopathy (PDR). Methods: The study involved 136 eyes of 114 PDR patients who underwent an initial vitrectomy between 2006 and 2008. Intravitreal VEGF levels were determined using Bio-Plex® (Bio-Rad), with levels of 5,000 pg/mL or more classified as high-VEGF (45 eyes) and levels lower than 5,000 pg/mL as low-VEGF (91 eyes). Diabetic control, PDR severity, and frequency of postoperative complications were compared between the groups. Results: There was no significant difference in preoperative status between the groups. In the low-VEGF group, a reoperation was required due to postoperative complications in 2 eyes (2.2%); 1 with vitreous hemorrhage (VH) and 1 with retinal detachment (RD). In contrast, a reoperation was required in 8 eyes (17.8%) in the high-VEGF group; 3 with VH, 2 with RD, and 3 with neovascular glaucoma. The difference between the groups was significant. There was a statistically lower postoperative corrected visual acuity logMAR (6 months after surgery) in the high-VEGF than in the low-VEGF group (p = 0.02, unpaired t test). Conclusion: Current findings indicate that careful observation is needed in patients with elevated VEGF levels.

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IV.A. Vitreous Physiology

Stefánsson

2014

Vitreous

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Intraocular VEGF Level as a Risk Factor for Postoperative Complications after Vitrectomy for Proliferative Diabetic Retinopathy

Abstract: High intraocular VEGF level at the time of primary vitrectomy in patients with PDR was identified as a significant risk factor for postoperative early VH.

Cited by 52 publications

References 32 publications

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

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

Level of Vascular Endothelial Growth Factor in the Vitreous Fluid of Proliferative Diabetic Retinopathy Patients and Prognosis after Vitrectomy

IV.A. Vitreous Physiology

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