Aqueous humor levels of vascular endothelial growth factor and pigment epithelium-derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization

PURPOSE: To determine the aqueous levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in patients with active polypoidal choroidal vasculopathy (PCV) and choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathologic myopia. DESIGN: Prospective, comparative control study. METHODS: Aqueous humors were collected from 32 eyes of 32 patients for either active PCV or CNV. Among them, 11 eyes had active and symptomatic PCV, 12 eyes had active CNV secondary to AMD, and nine eyes had active CNV of pathologic myopia. Levels of VEGF and PEDF were determined by commercially available enzyme-linked immunosorbent assay kits. A group of 10 aqueous samples from 10 patients who underwent cataract surgery without other ocular or systemic diseases comprised the controls. RESULTS: VEGF concentrations in aqueous humor were markedly increased in patients with PCV, CNV of AMD, and CNV of myopia when compared with the controls (analysis of variance [ANOVA], P < .001). VEGF levels in eyes with PCV were, however, significantly lower than those of exudative AMD (P = .045). The PEDF levels were also significantly different among the groups (ANOVA, P = .001), and we observed increased levels in PCV, CNV of AMD, and CNV of myopia. CONCLUSIONS: VEGF and PEDF factors were coexpressed and increased with positive correlation in aqueous humor of eyes with active PCV. The different levels of both factors in eyes of PCV and AMD might suggest distinct clinical entities or different angiogenesis courses between PCV and AMD.     

Pulsatile ocular blood flow of choroidal neovascularization in asymmetric age-related macular degeneration after transpupillary thermotherapy

PURPOSE: A previous study has shown that the pulsatile ocular blood flow (POBF) in eyes with asymmetric age-related macular degeneration (AMD) differs. Whereas eyes with drusen have higher POBF than contralateral eyes with disciform scarring, the POBF of eyes with drusen is lower relative to contralateral eyes with choroidal neovascularization (CNV). This study was designed to assess whether the POBF of eyes with CNV changes after transpupillary thermotherapy (TTT), using the contralateral eyes with drusen or scarring without TTT as controls. METHODS: In total, 26 patients with CNV in one eye and drusen or scarring in the other were enrolled in this prospective case series. Eyes with CNV were treated with TTT. POBF was measured monthly in both eyes of each subject. RESULTS: Before TTT, the POBF of eyes with CNV was 1179+/-317 microl/min. After TTT, the POBF of CNV eyes had decreased at 1 month (1015+/-273 microl/min, P=0.002) and 2 months (945+/-398 microl/min, P=0.011) of follow-up, but had rebounded at 3 months (P=0.441) and 6 months (P=0.084). CONCLUSIONS: These findings suggest that TTT decreases the pulsatile choroidal blood flow in eyes with CNV in patients with asymmetric AMD and the effects persist for 2 months. POBF may be used as a modality to monitor the therapeutic effects of CNV in asymmetric exudative AMD.     

Unbalanced vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in diabetic retinopathy

PURPOSE: To determine the levels of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF) in the vitreous of patients with diabetic retinopathy (DR). DESIGN: Experimental study of PEDF and VEGF levels in vitreous samples collected during vitrectomy. METHODS: The levels of PEDF and VEGF were measured by enzyme-linked immunosorbent assay in the vitreous of 46 eyes of 43 patients who underwent vitrectomy with diabetic retinopathy (DR) (32 eyes of 29 patients) and an idiopathic macular hole (MH) (14 eyes of 14 patients). RESULTS: The vitreal concentration of PEDF was significantly lower at 1.11 +/- 0.14 microg/ml (mean +/- standard error) in eyes with DR than in eyes with MH at 1.71 +/- 0.22 microg/ml (P =.021). The VEGF level was 1799 +/- 478 pg/ml in eyes with DR and not detectable in MH. The PEDF level in proliferative DR (PDR) (0.94 +/- 0.12 microg/ml) was lower than that in nonproliferative DR (NPDR) (2.25 +/- 0.32 microg/ml), and that in active DR (0.85 +/- 0.14 microg/ml) was significantly lower than that in inactive DR (1.59 +/- 0.24 microg/ml; P =.01). The VEGF level was 2025 +/- 533 pg/ml in PDR and 215 +/- 201 pg/ml in NPDR and that in active DR (2543 +/- 673 pg/ml) was significantly higher than that in inactive DR (395 +/- 188 pg/ml; P =.0098). CONCLUSIONS: These results suggest that lower levels of PEDF and higher levels of VEGF may be related to the angiogenesis in DR that leads to active PDR.     

Stimulation of neovascularization by the anti-angiogenic factor PEDF

PURPOSE: Examine the effect of (pigment epithelium-derived growth factor; PEDF) on laser-induced choroidal neovascularization (CNV). METHODS: Adult C57Bl/6 mice were anesthetized and four laser spots were placed in each quadrant of the fundus with a krypton red laser (614 nm, 50 microm, 0.05 second, 200 mW). Animals were treated with various doses of PEDF administered with miniosmotic pumps implanted subcutaneously. Seven days after laser treatment, mice were perfused with 3% FITC high-molecular-weight dextran, the eyes enucleated, and neovascularization analyzed by confocal microscopy. Data were recorded as the volume of the neovascular complex. The effect of PEDF on endothelial cell migration, vascular tube formation in synthetic basement membrane, and VEGF production was also determined. RESULTS: Mice receiving a lower dose of PEDF (90 microg/mL) had significantly decreased areas of CNV. A high dose of PEDF (360 microg/mL) significantly increased CNV, whereas an intermediate dose (180 microg/mL) of PEDF had no effect. PEDF inhibited endothelial cell migration and vascular tube formation at lower doses (0.5-5 microg/mL). High doses of PEDF (25-50 microg/mL) stimulated endothelial cell migration, enhanced vascular tube formation in vitro, and stimulated VEGF production from endothelial cells. Neutralizing anti-VEGF antibody completely reversed the stimulatory effects of high doses of PEDF on CNV in vivo. CONCLUSIONS: PEDF demonstrates opposing effects on CNV and endothelial cell function. Whereas low doses are inhibitory, high doses can augment the development of the neovasculature. These results suggest that the effects of PEDF on neovascularization are more complex than originally believed and that caution should be exercised when PEDF therapies are considered.     

Molecular mechanism of choroidal neovascularization in age-related macular degeneration

The exudative form of age-related macular degeneration (AMD) is characterized by choroidal neovascularization (CNV). Retinal pigment epithelial cells (RPE) secrete various angiogenesis-related factors, especially vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF). The imbalance between the VEGF and PEDF secreted by RPE is a key contributor to the development of CNV in AMD. The earliest clinical hallmark of AMD is the presence of drusen. Although drusen are an epidemiological risk factor for the development of CNV, the mechanism of how drusen induce the development of CNV remains unclear. Recent proteome analysis demonstrated that amyloid beta (Abeta) deposition was specific to drusen from eyes with AMD. We focused on Abeta and investigated the effect of Abeta on cultured human RPE cells as well as ocular findings in neprilysin gene-disrupted mice, which leads to an increased deposition of Abeta. Our study demonstrates that Abeta accumulation affects the balance between VEGF and PEDF in the RPE, and reproduces features characteristic of human AMD, such as RPE atrophy and basal deposit formation in neprilysin gene-disrupted mice.     

Pigment epithelium-derived factor suppresses ischemia-induced retinal neovascularization and VEGF-induced migration and growth

PURPOSE: To determine the effect of pigment epithelium-derived factor (PEDF) in a mouse model of ischemia-induced retinal neovascularization and on vascular endothelial growth factor (VEGF)--induced migration and growth of cultured microvascular endothelial cells. METHODS: Human recombinant PEDF was expressed in the human embryonic kidney 293 cell line and purified by ammonium sulfate precipitation and cation exchange chromatography. C57BL/6 mice were exposed to 75% oxygen from postnatal day (P)7 to P12 and then returned to room air. Mice received intravitreal injections of 2 microg PEDF in one eye and vehicle in the contralateral eye on P12 and P14. At P17, mice were killed and eyes enucleated for quantitation of retinal neovascularization. The mitogenic and motogeneic effects of VEGF on cultured bovine retinal and adrenal capillary endothelial cells were examined in the presence or absence of PEDF, using cell counts and migration assays. RESULTS: Two species of human recombinant PEDF, denoted A and B, were purified to apparent homogeneity. PEDF B appeared to comigrate on SDS-PAGE with PEDF from human vitreous samples. Changes in electrophoretic mobility after peptide-N-glycosidase F (PNGase F) digestion suggest that both PEDF forms contain N-linked carbohydrate. Analyses of the intact proteins by liquid chromatography-electrospray mass spectrometry (LC-ESMS) revealed the major molecular weight species for PEDF A (47,705 +/- 4) and B (46,757 +/- 5). LC-ESMS analysis of tryptic peptides indicated that PEDF A and B exhibit differences in glycopeptides containing N-acetylneuraminic acid (NeuAc) and N-acetylhexosamine (HexNAc). Intravitreal administration of either species of PEDF significantly inhibited retinal neovascularization (83% for PEDF A and 55% for PEDF B; P = 0.024 and 0.0026, respectively). PEDF A and B (20 nM) suppressed VEGF-induced retinal microvascular endothelial cell proliferation by 48.8% and 41.4%, respectively, after 5 days (P < 0.001) and VEGF-induced migration by 86.5% +/- 16.7% and 78.1% +/- 22.3%, respectively, after 4 hours (P = 0.004 and P = 0.008, respectively). CONCLUSIONS: These data indicate that elevated concentrations of PEDF inhibit VEGF-induced retinal endothelial cell growth and migration and retinal neovascularization. These findings suggest that localized administration of PEDF may be an effective approach for the treatment of ischemia-induced retinal neovascular disorders.     

Molecular mechanism for choroidal neovascularization in age-related macular degeneration

Choroidal neovascularization (CNV) in age-related macular degeneration (AMD) is the most common cause of severe visual loss in patients over age 60 years in developed countries. While much is unknown about the underlying pathogenesis of CNV, the increased production of vascular endothelial growth factor(VEGF) by retinal pigment epithelium (RPE) is thought to play a central role in the development of this condition. However, recent studies using gene-manipulated mice question the importance of VEGF alone in promoting CNV. Angiogenesis is thought to result from the balance between angiogenesis stimulation and inhibition. A potent antiangiogenic factor recently has been identified in the retina and shown to be secreted by RPE cells. The inhibitor, pigment epithelium-derived factor(PEDF) is considered the key factor associated with avascularity of the cornea, vitreous, and outer retinal layer of the eye. We recently demonstrated that an imbalance between PEDF and VEGF in RPE cells caused by aging and oxidative stress may contribute to the disregulation of endothelial cell proliferation in CNV. In this review, we also discuss the angiogenic role of inflammatory cells in CNV, age-related changes in Bruch's membrane, and the possibility of the development of animal models reflecting CNV in AMD.     

Surgical treatment of subfoveal neovascularization in myopia: macular translocation vs surgical removal

PURPOSE: To compare the visual outcome of two different surgical approaches for subfoveal neovascularization in degenerative myopia: macular translocation and surgical removal of choroidal neovascularization (CNV). DESIGN: Interventional case series. METHODS: Retrospectively, 32 eyes with degenerative myopia (axial length over 26 mm or refraction over -6 diopters) and subfoveal CNV of 32 consecutive patients operated on by either surgical removal of CNV or limited macular translocation were reviewed. Surgical removal of CNV was performed in 18 eyes and limited macular translocation with a twofold suture in 14 eyes. The main outcome measurements were best-corrected visual acuity (BCVA) and findings from fluorescein angiography. Postoperatively, mean +/- SD follow up was 14 +/- 15 months (range, 6-48 months) in the removal group and 11 +/- 4 months (range, 6-24 months, P =.37) in the translocation group. RESULTS: In both groups, there was no significant difference in preoperative age, sex, refractive error, or BCVA. The average of postoperative BCVA was statistically better after macular translocation (10 ETDRS lines or 20/100) than after surgical removal (6 lines 10/125, P =.019). Visual acuity improved by 3.8 lines after macular translocation and was unchanged after surgical removal (-0.7 line, P =.011). Macular translocation was successful in shifting the CNV to an extrafoveal location in 11 out of 14 eyes. Mean foveal displacement of all 18 translocated eyes was 695 +/- 426 microm (range, 100-1520 microm). Recurrence of CNV occurred in seven eyes (39%) after surgical removal and in two eyes (14%) after translocation. Retinal detachment occurred in two eyes in each group. CONCLUSION: In this retrospective study, eyes with degenerative myopia and subfoveal neovascularization treated with limited macular translocation had better visual acuity recovery than eyes treated with surgical removal of the choroidal neovascularization. Further studies are required to confirm these results.     

老年性黄斑变性脉络膜新生血管与脉络膜分水带

目的 观察老年性黄斑变性（age-related macular degeneration ,AMD）的脉络膜新生血管(choroidal neovascularization,CNV)与黄斑区脉络膜分水带(choroidal watershed zones，CWZ)的关系。 方法 对比分析AMD 患者57例57只眼以及与之年龄相匹配的无AM D的患者35例35只眼的吲哚青绿血管造影（indocyanine green angiography, ICGA)资料，观 察CNV与黄斑区CWZ的关系。 结果 57只AMD眼中，35只眼有黄斑区CWZ，占61.4%；对照组35只眼中，3只眼有黄斑区CWZ，占8.57%，两者比较差异有显著性的意义（P<0.05)。在有CNV的43只渗出型AMD眼中，32只眼有黄斑区CWZ，占74.4%，其中29只眼的CNV来自黄斑区 CWZ，占90.6%。 结论 黄斑区CWZ可能是渗出型AMD的CNV好发部位。 （中华眼底病杂志，2003，19：76-78）     

Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy

PURPOSE: To examine the impact of photodynamic therapy (PDT) on pigment epithelium derived factor (PEDF) expression in human choroidal neovascularization (CNV) membranes with regard to vascular endothelial growth factor (VEGF) expression. DESIGN: Interventional case series. METHODS: Retrospective review of interventional case series of 42 patients (42 eyes) who underwent removal of CNV. CNV was secondary to age-related macular degeneration (AMD) in all cases. Fifteen patients were treated with PDT, 3 to 246 days before surgery. CNV were stained for CD34, CD105, cytokeratin 18, VEGF, and PEDF. Twenty-seven CNV without previous treatment were used as control. RESULTS: Specimens without pretreatment disclosed varying degrees of vascularization, VEGF, and PEDF expression by different cells. Specimens treated by PDT, three days previously showed mostly occluded vessels lined with damaged endothelial cells (EC). In contrast, specimens excised at later time points after PDT were highly vascularized with healthy EC. This chronology was associated with an impressive VEGF immunoreactivity increased considerably in retinal pigment epithelial cells as well as significantly reduced PEDF expression in EC and stroma. CONCLUSIONS: PDT induces a selective vascular damage in CNV. The effectiveness of PDT, however, seems to be jeopardized by a rebound effect initiated by an enhanced VEGF and reduced PEDF expression in CNV.     

Natural course of occult choroidal neovascularization in age-related macular degeneration: development of classic lesions in fluorescein angiography

PURPOSE: To analyse the frequency of conversion from occult with no classic choroidal neovascularization (CNV) and occult with minimally classic CNV into predominantly classic CNV secondary to age-related macular degeneration. METHODS: Retrospective evaluation of baseline and repeat angiograms of 54 eyes with a follow-up of 6-12 months. RESULTS: In the group with initially occult with no classic CNV, nine of 40 eyes (23%) progressed to a predominantly classic lesion, whereas in the group of occult with a minimally classic CNV, 10 of 14 eyes (71%) eyes developed a predominantly classic CNV. CONCLUSIONS: The proportion of eyes that develop predominantly classic CNV is much higher in eyes with initially occult and minimally classic CNV, compared with eyes with initially occult and no classic CNV. Our data suggest that the natural course of CNV secondary to AMD begins as occult and progresses to classic CNV.     

Effect of Quercetin on Formation of Choroidal Neovascularization (CNV) in Age-related Macular Degeneration(AMD)

Purpose: Age-related macular degeneration (AMD) as a disease entity is "dry" at early stage and made up of two main components at late stage:atrophic AMD and exudative AMD. Quercetin acts as an anti-oxidant to protect retinal pigment epithelial cells (RPE) from damaged by oxidative stress, but its effect on formation of choroidal neovascularization (CNV)in AMD is unclear. The aim of this study is to investigate the effect of quercetin on the formation of CNV in AMD. Methods:The development of CNV induced by laser was detected by fluorescein angiography (FA). Colored microsphere technique was used to determine the choroidal blood flow in ocular hypertensive rabbit eyes.In in vitro studies, HUVECs were treated with NaIO3, H2O2 and NaN3 to induce oxidative cell damages. The effect of quercetin on various oxidationsinduced injuries in HUVECs was measured by MTT assay. HUVECs migration was assessed using a wound healing assay. Results:Quercetin significantly inhibited the formation of laser-induced CNV.The choroidal blood flow in rabbit eyes was significantly increased after quercetin instillation. In vitro results showed quercetin enhanced various oxidations-induced injuries in HUVECs and inhibited migration of HUVECs during wound healing. Conclusion: Quercetin inhibited the formation of CNV both in vivo and in vitro and increased choroidal blood flow.It could become a promising candidate for the treatment of AMD.     

Balance of vascular endothelial growth factor and pigment epithelial growth factor prior to development of proliferative vitreoretinopathy

BACKGROUND: Pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF) are imbalanced in eyes with proliferative diabetic retinopathy or proliferative vitreoretinopathy (PVR). It is not known whether such an imbalance is already present in early PVR stages. We therefore analyzed VEGF and PEDF concentrations in subretinal fluids prior to PVR development. METHODS: A large number (n = 137) of subretinal fluid samples were obtained at the time of scleral buckling surgery for rhegmatogenous retinal detachment (RRD). Thirty patients developed PVR within 6 months after surgery. One hundred and seven patients undergoing the same surgery but without complications served as controls. Furthermore, vitreous from 16 patients with macular hole or pucker (MHP) served as reference for baseline intraocular concentrations. PEDF and VEGF concentrations were measured by commercial ELISAs. RESULTS: PEDF levels were substantially higher (9.6 microg/ml) compared to MHP vitreous (0.3 microg/ml, p < 0.001). VEGF levels were also higher (RRD: 0.07 ng/ml; MHP: 0.01 ng/ml, p < 0.05). Subretinal concentrations were not significantly different between PVR and control RRD patients. CONCLUSIONS: Although both VEGF and PEDF are increased at first surgery for RRD, they do not predict PVR development later on. The high PEDF concentrations and its known antiangiogenic activity suggest a protective role against neovascularization.     

The vitreomacular interface in different types of age-related macular degeneration

AIM: To evaluate the vitreomacular interface in cases with wet age-related macular degeneration (AMD) and to compare them to eyes with dry AMD and normal eyes. METHODS: This was a cross-sectional comparative study that included 87 eyes with wet AMD, 42 eyes with dry AMD and 40 eyes without AMD as a control group. Optical coherence tomography (OCT) examination was performed for all patients to assess the vitreomacular interface. RESULTS: In the wet AMD group, 34.5% of cases had vitreomacular adhesion (VMA). Only 14.3% of dry AMD cases and 10% of control cases had VMA. There was a significant difference between the control group and the wet AMD group (P=0.004) as well as the dry and wet AMD group (P=0.017). There was also a significant difference between the incidence of VMA in patients with subretinal choroidal neovascularization (CNV, type 1) and intraretinal CNV (type 2 or type 3) (P=0.020). CONCLUSION: There is an association between posterior vitreous attachment and AMD. There is also an increased incidence of VMA with intra-retinal CNV.     

A retrospective pilot study of indocyanine green enhanced diode laser photocoagulation for subfoveal choroidal neovascularization associated with age-related macular degeneration

PURPOSE: The effectiveness and limitations of indocyanine green (ICG) enhanced diode laser photocoagulation in treating subfoveal choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD) were investigated retrospectively. METHODS: Thirty-eight eyes of 37 patients with subfoveal CNV received ICG enhanced diode laser (wavelength, 805 nm) photocoagulation in our preliminary series. Nineteen eyes had classic CNV and the others had occult CNV, which was well-delineated on ICG angiography. The rate of anatomical success and functional outcomes were investigated. Factors prognostic of a final visual acuity of 0.1 or better were analyzed. The follow-up period ranged from 6 to 51 months (mean +/- SD = 26.5 +/- 14.4 months). RESULTS: Occlusion of CNV was achieved in 35 of 38 eyes (92%), and 7 eyes (18%) showed recurrence, which was occluded by retreatment in all but 1 eye. Ten eyes (26.3%) showed improvement of visual acuity; 16 (42.1%) showed no change; and in 12 eyes (31.6%) visual acuity deteriorated. Factors prognostic of a final visual acuity of 0.1 or better were good preoperative visual acuity (Mann-Whitney U-test, P =.0028), and a relatively short distance between the edge of laser burns and the center of the foveal avascular zone (unpaired t-test, P =.0285). CONCLUSION: Indocyanine green enhanced photocoagulation achieved a higher anatomical success rate but functional outcomes equal to those with argon or krypton laser photocoagulation. A controlled prospective study is necessary to prove the efficacy of this treatment.     

Progression of choroidal neovascularization after macular translocation in age-related macular degeneration and degenerative myopia

PURPOSE: To study the progression of choroidal neovascularization (CNV) after macular translocation in age-related macular degeneration (AMD) and degenerative myopia. PATIENTS AND METHODS: The data from 42 consecutive eyes (28 AMD, and 14 degenerative myopia) operated on by limited macular translocation (DeJuan technique), with a follow-up of 6 months or more, were prospectively analyzed. In the AMD group, neovascularization was classic in 54% of eyes and classic and occult in 46% of eyes. Previous laser treatment was applied on extra- or juxtafoveal CNV in 3 eyes. The major outcome measures were visual acuity, fluorescein and indocyanine green angiographies. RESULTS: After translocation, foveal displacement was greater in AMD than in myopic eyes (mean: 1 260 and 812 micro m, respectively). Laser photocoagulation was applied postoperatively onto extra-or juxtafoveal CNV in 26 (93%) AMD eyes and 12 myopic eyes (86%). Mean follow-up was 10 months (range, 6-18 months). Recurrence of CNV occurred in 14 AMD eyes (50%) and 2 myopic eyes (14%) an average of 5.6 months after surgery (range, 1-18 months). Recurrence was more frequent in AMD eyes with preoperative occult CNV (66%) than without (36%). Recurrence reached the new fovea in 69% of cases. Supplementary laser treatment was possible and successful on extra- or juxtafoveal recurrence in 3 eyes. Recurrence was significantly correlated with a poor visual prognosis: eyes without recurrence or with extra- or juxtafoveal recurrence had a final gain in visual acuity of 2.4 lines, eyes with subfoveal recurrence had a loss of 1.3 lines, and eyes with diffuse recurrence had a loss of 4.2 lines. CNV appeared in a new area at a BSS injection site in one eye. Occult CNV seemed to fade relatively within the first postoperative weeks, but were unchanged at the end of follow-up. In one eye, a small polypoidal lesion near the disc noted preoperatively disappeared after surgery. CONCLUSION: Our results suggest that the surgical procedure does not affect the course of classic or occult CNV. The rate of recurrence of CNV after macular translocation seemed similar to that observed after conventional laser treatment for extrafoveal CNV in AMD. Neovascular recurrence is the most frequent postoperative complication and was frequently directed at the new fovea. Despite these complications, macular translocation moves CNV outside of the subfoveolar zone so the eyes can be treated with conventional laser, leading to a favorable outcome at the last follow-up in 57% of cases. Further studies are required to confirm these findings and to define the best criteria for treatment.     

Longterm results in surgical removal of subfoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: This study aimed to analyse visual outcome, surgical complications and recurrence rates 3 years after removal of subretinal choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). METHODS: The study involved a retrospective analysis of 50 eyes of 50 patients who underwent surgical removal of CNV in AMD between February 1996 and June 1998. The minimum follow-up period was 36 months. Improvement or worsening of visual acuity (VA) was defined as a change of more than two lines. RESULTS: The mean reduction in VA was 2.2 +/- 6.9 lines. Visual acuity improved in 12 eyes, remained stable in 16 eyes and worsened in 22 eyes. Recurrence of CNV occurred in three eyes. CONCLUSION: After surgical excision of age-related subfoveal CNV, VA improved or stabilized in a large group of patients. Considering the development of VA and the low recurrence rate, surgical treatment seems to be beneficial compared to the natural course of CNV over a longterm follow-up of more than 3 years.     

Pulsatile ocular blood flow in asymmetric age-related macular degeneration

PURPOSE: Ocular perfusion abnormalities have been proposed in the pathogenesis of age-related macular degeneration (AMD) with differences in pulsatile ocular blood flow (POBF) in eyes with asymmetric AMD in Japanese and Taiwanese patients. The purpose of our study was to observe POBF difference in the fellow eyes of Caucasians with asymmetric AMD. METHODS: This was a cross-sectional study comparing POBF in three groups of patients with asymmetric AMD in the fellow eyes: Group 1 (n=21) with drusen and active choroidal neovascularisation (CNV); Group 2 (n=18) with drusen and disciform scar; Group 3 (n=8) with CNV and disciform scar. The POBF was adjusted for intraocular pressure (IOP), pulse rate (PR), and axial length using multiple regression analysis. Generalised estimation equation model was used to include both eyes in each group. RESULTS: The geometric mean (95% confidence interval) POBF values were as follows: Group 1 with drusen 1097.9 microl/min (957.0, 1259.7) in one eye and the fellow eye with CNV 1090.1 microl/min (932.3, 1274.7); Group 2 with drusen 946.0 microl/min (794.2, 1126.7) and disciform scar 966.2 microll/min (780.3, 1196.4); Group 3 with CNV 877.1 microl/min (628.3, 1224.6) and disciform scar 767.2 microl/min (530.5, 1109.7). Adjusting for differences in axial length, pulse rate and intraocular pressure, no statistically significant difference in POBF was found between fellow eyes in the same subject. CONCLUSIONS: POBF is not different between fellow eyes of Caucasian patients with asymmetric AMD.     

Hepatocyte growth factor levels in the vitreous of patients with proliferative vitreoretinopathy

PURPOSE: To determine whether the hepatocyte growth factor is increased in the vitreous of patients with proliferative vitreoretinopathy. METHODS: We assayed hepatocyte growth factor levels by enzyme-linked immunosorbent assay (ELISA) in vitreous samples from 65 consecutive eyes (65 patients) with proliferative vitreoretinopathy (23 eyes), rhegmatogenous retinal detachment (22 eyes), and macular hole or idiopathic epiretinal membrane (control subjects, 20 eyes) having undergone pars plana vitrectomy. RESULTS: Vitreous levels of hepatocyte growth factor were 3.94 +/- 2.29 (mean +/- SD) ng/ml in proliferative vitreoretinopathy, 2.02 +/- 0.84 ng/ml in rhegmatogenous retinal detachment, and 2.16 +/- 1.39 ng/ml in the control subjects. The vitreous levels in proliferative vitreoretinopathy were much greater than levels in rhegmatogenous retinal detachment (P =.0002) and in the control subjects (P =.0007). In proliferative vitreoretinopathy, there was a tendency toward higher levels in eyes with grade D by the Retina Society terminology. CONCLUSION: The results suggest the possibility that hepatocyte growth factor may play a role in the pathogenesis of proliferative vitreoretinopathy.