增殖性糖尿病视网膜病变的玻璃体手术和光凝治疗

目的评价玻璃体手术联合光凝治疗一组增殖性糖尿病视网膜病变(proliferative diabeticretinopathy,PDR)的效果.方法对1997年2月至2000年5月之间经玻璃体手术和激光治疗的一组PDR连续的病例进行回顾性研究.结果共包括79例(男38,女41)、104只眼(右26,左28;双眼25例).发现糖尿病史0.5-37 a(8.5±6.5 a),发现眼病史15 d-8 a(1.5±1.5 a).30只眼有视网膜光凝史,但其中26只眼仅光凝一次.手术采用玻璃体切除、新生血管膜切除或切碎、眼内电凝及光凝;对有活动性出血、视网膜脱离或严重缺血的眼,术毕注入硅油(59只眼).手术中联合白内障摘除63只眼和人工晶状体植入27只眼.术前视力为光感、手动和指数的分别有15、38和22只眼,≥0.02的29只眼(27.8%).术后视力提高的有84只眼(80.8%),不变和下降的20只眼(19.2%).其中,术后视力≥0.1的41只眼(39.4%).术后2只眼发生新生血管性青光眼.结论本组多数PDR眼在手术前未得到有效的光凝治疗.经玻璃体手术和光凝,大多数患眼避免了失明或改善了视力.对视网膜脱离、严重缺血和手术中活动性出血的眼,注入硅油可在手术后及早补充视网膜光凝,以阻止病情恶化.眼科学报2001;17241～244.     

全玻璃体切除联合超全视网膜光凝术治疗增生性糖尿病性视网膜病变

目的 探讨全玻璃体切除术联合超全视网膜光凝治疗增生性糖尿病性视网膜病变(PDR)的疗效.方法 PDR患者12例(13只眼),均行全玻璃体切除术联合超全视网膜光凝术.其中7只眼联合白内障超声乳化手术,3只眼硅油充填,10只眼C<,3>F<,8>气体填充.结果 术后3～10个月随访,13只眼视网膜平伏.2只眼视力无提高,11只眼视力均有不同程度的提高.有效率84.62%.结论 全玻璃体切除术联合超全视网膜光凝是治疗PDR安全有效的方法.     

玻璃体中血管内皮生长因子及色素上皮衍生因子水平的研究

目的 检测增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者玻璃体中血管内皮生长因子(vascular endothelial growth factor,VEGF)及色素上皮衍生因子(pigment epithelium-derived factor,PEDF)水平,了解玻璃体手术后糖尿病性视网膜病变的进展是否与术前VEGF及PEDF水平有关.方法 采集行玻璃体切除术患者58例(60眼)的玻璃体样本,其中PDR患者28例(30眼),孔源性视网膜脱离患者30例(30眼),用酶联免疫吸附法检测玻璃体中VEGF及PEDF水平,随访观察玻璃体手术后糖尿病性视网膜病变的进展情况.结果 PDR组玻璃体中的VEGF及PEDF浓度分别为(4 187.21±316.35)pg/mL和(25.01±11.85)μg/mL,高于孔源性视网膜脱离组的(3 949.93±441.94)pg/mL和(17.06±10.16)μg/mL(P＜0.05).PDR组在随访中失访7例,糖尿病性视网膜病变进展患者5例(6眼),糖尿病性视网膜病变无进展患者16例(17眼),PDR组中进展和无进展患者玻璃体中VEGF及PEDF浓度的差异无统计学意义(P=0.889;P=0.624).结论 VEGF及PEDF可能共同参与调节增殖性糖尿病视网膜病变的形成,但并不支持下调PEDF作为这种调节机制的假设.PDR患者术前玻璃体中VEGF及PEDF浓度尚不能作为预测玻璃体手术后糖尿病性视网膜病变是否进展的依据.(中国眼耳鼻喉科杂志,2007,7:347-349)     

抗VEGF辅助PPV治疗增生性糖尿病视网膜病变的效果及作用机制分析

目的:探讨抗血管内皮生长因子(vascular endothelial growth factor,VEGF)辅助玻璃体切割术(pars plana vitrectomy,PPV)治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的效果及作用机制.方法:将92例92眼行PPV的PDR患者,根据术前有无玻璃体腔注射雷珠单抗(intravitreal ranibizumab,IVR)分为单纯PPV组(41例41眼)和联合治疗组(51例51眼),其中联合治疗组于PPV术前5~7 d进行IVR.比较两组手术时间、电凝次数、硅油填充率、术后并发症发生率、术后3 mo患眼BCVA及手术前后不同时间点房水和玻璃体VEGF、色素上皮衍生因子(pigment epithelium-derived factor,PEDF)含量.结果:联合治疗组手术时间短于单纯PPV组,电凝次数少于PPV组,硅油填充、医源性视网膜裂孔及玻璃体再积血的几率均低于单纯PPV组,差异均有统计学意义(P<0.05);联合治疗组PPV时房水及玻璃体VEGF、PEDF含量低于单纯PPV组,差异均有统计学意义(P<0.05);联合治疗组术后3 mo患眼BCVA好于单纯PPV组,差异有统计学意义(P<0.05).结论:IVR联合PPV治疗PDR可降低PPV围手术期VEGF、PEDF水平,减少术中电凝次数,降低术后医源性视网膜裂孔及玻璃体再积血发生率,提高视力水平.     

预防性玻璃体手术治疗急性视网膜坏死综合征

目的 报告一组Ⅰ～Ⅱ期急性视网膜坏死综合征患者经预防性玻璃体手术治疗的临床效果.方法 回顾性分析2006年2月至2008年7月20例(20只眼)Ⅰ～Ⅱ期急性视网膜坏死综合征患者接受预防性玻璃体手术治疗的临床资料.所有患者接受完全玻璃体切除联合激光光凝及硅油填充,术中用曲安奈德玻璃体腔注射以增加玻璃体可视性,术后常规面朝下体位,术前、术后均给予阿昔洛韦等药物治疗.随防10～12月.结果 20例20只眼中,硅油取出后,18只眼视网膜在位;2只眼出现视网膜脱离,其中1只眼再次行视网膜前膜剥除+硅油注入+激光光凝术,硅油取出后,视网膜在位;另1只眼因术前视网膜坏死广泛,视网膜动脉广泛闭塞,再次手术后,视网膜未能复位.术后视力提高13只眼、不变5只眼、下降2只眼.结论 预防性玻璃体切除联合激光光凝及硅油填充是治疗急性视网膜坏死综合征的有效方法,术后患者能改善或保持视力,减少视网膜脱离的发生率.     

增殖性糖尿病视网膜病变眼内组织纤溶酶原激活物及其抑制物的表达与VEGF表达的相关性研究

目的:探讨增殖性糖尿病视网膜病变(PDR)中组织纤溶酶原激活物(t-PA)及纤溶酶原激活物抑制剂(PAI)的表达以及与血管内皮生长因子(VEGF)表达的相关性.方法:于玻璃体手术中采集PDR 35眼玻璃体,同时采集因黄斑裂孔行玻璃体手术20眼玻璃体作为对照组,采用酶联免疫吸附法检测t-PA及PAI的表达浓度,并与VEGF的表达进行相关性分析.结果:PDR眼玻璃体中VEGF、t-PA及PAI的表达浓度均显著高于对照眼玻璃体(P＜0.001).t-PA及PAI的表达与VEGF的表达经统计学分析,均存在显著相关性(P＜0.001).结论:在PDR眼内视网膜新生血管的发生过程中不仅有VEGF,可能同时有多种生物活性物质的参与.     

玻璃体切除联合不同眼内填充物治疗增性糖尿病视网膜病变的效果分析

目的 评估增殖型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)行玻璃体切割术的治疗效果.对PDR不同分期以及联合不同填充物的视力和并发症情况进行观察和比较,探讨其预后的差别.方法 对因PDR行玻璃体手术的病例300例(384只眼)进行随访,根据玻璃体切割术后不同填充物分为硅油填充组、全氟丙烷填充组和平衡盐水组三组,比较各组间的视力预后及并发症发生情况.结果 (1)术后视力:在观察的384只眼中,随访时视力较术前提高者有271只眼(70.6%);其中保留BSS灌注液患者中有78只眼(84.8%),填充气体患者有58眼(70.7%),填充硅油患者135只眼(64.3%)视力提高.经x2检验,各组间视力提高比例的差别无统计学意义(均P>0.05).(2)术后并发症:玻璃体再出血发生率以填充BSS组最高(23.9%),与硅油填充组(10.5%)比较差异有统计学(P<0.05);并发性白内障以硅油填充组(26.4%)最高,与填充BSS组相比差异具有统计学意义(P<0.05);视网膜脱离发生率以硅油填充组最高,与填充BSS组相比差异具有统计学意义(P<0.05);不同填充物各组间虹膜红变发生率未显示统计学差异.结论 (1)玻璃体切割联合不同填充物能有效地控制病情,及时有效的玻璃体手术是挽救严重PDR患者有用视功能的关键.(2)玻璃体出血、视网膜脱离、并发性白内障和青光眼是PDR患者玻璃体切割术后主要的并发症.硅油填充组的玻璃体出血发生率少于其他组,但并发性白内障发生率较其他组高;(3)尽管玻璃体切割术联合硅油填充会引起一些并发症,但硅油有屏障、限制出血扩散和视网膜复位的作用,为进一步完成全视网膜激光光凝创造了条件,巩固了手术治疗的效果,明显提高视网膜复位率及手术治疗成功率     

玻璃体切除术中全视网膜光凝治疗晚期增生性糖尿病视网膜病变

目的 探讨玻璃体手术结合眼内激光一次性全视网膜光凝术治疗晚期增生性糖尿病视网膜病变(PDR)的疗效。方法 晚期PDR患者56例(56只眼),其中牵引性视网膜脱离者32例(32只眼)。所有患者均行玻璃体切除术和全视网膜光凝,约光凝800～1000个光斑。观察患者术前后视力、房水、晶状体、玻璃体、视网膜改变情况,分析患者术后荧光素眼底血管造影结果和并发症。结果 术后随访时间≥3个月,52只眼玻璃体腔和眼底均清晰,视网膜保持复位,未见新鲜出血、渗出灶及新生血管等。32只眼术后行荧光素眼底血管造影检查,其中28只眼未见无灌注区。术后视力提高者52只眼。结论 眼内全视网膜光凝具有所需能量小、有效率高、并发症少、术后反复出血发生率低等优点。对于晚期PDR患者,在玻璃体切除术中行一次性全视网膜光凝,疗效满意,手术安全。     

微创玻璃体切割联合白内障超声乳化术治疗增生性糖尿病视网膜病变的临床疗效

目的探讨微创玻璃体切割联合白内障超声乳化术治疗增生性糖尿病视网膜病变（PDR）的临床疗效。方法回顾性分析PDR患者16例（16只眼）均行微创玻璃体切割联合白内障超声乳化术,术中行全视网膜光凝。其中3只眼行硅油填充,6只眼行气体（C3F8）填充,术后3—6个月行硅油取出术,术后随访6个月。结果16只眼随访12个月,视网膜复位良好,12只眼矫正视力显著提高,4只眼因视神经萎缩视力无提高,3只眼后囊增生明显。结论微创玻璃体切割联合白内障超声乳化术是治疗PDR有效的方法,具有良好的临床前景。     

玻璃体手术联合眼内激光治疗出血性玻璃体视网膜疾病

目的 探讨玻璃体切除术联合眼内光凝治疗出血性璃体视网膜疾病的临床效果.方法 对37例(37只眼)玻璃体积血行玻璃体切除术联合眼内光凝、膜剥离、部分行眼内惰性气体或硅油填充.结果 增生性糖尿病视网膜病变13只眼,视网膜静脉阻塞11只眼,视网膜静脉周围炎8只眼,孔源性视网膜脱离玻璃体积血5只眼.术后随访3～36个月,平均(11±2.4)个月,37只眼视力均有不同程度的提高,0.05以上者31只眼(83.78%),与术前相比差异有统计学意义(P<0.05).结论 玻璃体手术联合眼内激光是治疗出血性玻璃体视网膜疾病的有效方法.     

Risk evaluation of outcome of vitreous surgery for proliferative diabetic retinopathy based on vitreous level of vascular endothelial growth factor and angiotensin II

AIMS: To ascertain whether measurement of the vitreous fluid levels of vascular endothelial growth factor (VEGF) or angiotensin II (Ang II) could predict the outcome of vitreous surgery in patients with proliferative diabetic retinopathy (PDR). METHODS: A prospective observational case study was performed in 61 consecutive patients (61 eyes) with PDR who underwent vitreoretinal surgery. Vitreous fluid samples were obtained during surgery. The VEGF level in vitreous fluid and plasma was determined by enzyme linked immunosorbent assay, while the Ang II level was measured by radioimmunoassay. Patients were prospectively followed for 6 months and the postoperative outcome was analysed by logistic regression analysis. RESULTS: No improvement and/or progression of PDR was seen in 15 (25%) of the 61 eyes. Vitreous levels of VEGF and Ang II were significantly higher in eyes with progression of PDR than in eyes with regression of PDR (p = 0.0044, and p = 0.0178, respectively). Multivariate logistic regression analysis showed that the vitreous VEGF level increased along with the progression of PDR after vitreous surgery (odds ratio 2.48, p = 0.0008). CONCLUSION: A high vitreous fluid VEGF level is associated with a significant risk of postoperative progression of PDR. The vitreous level of VEGF at the time of surgery may be a useful predictor of the outcome.     

Risk evaluation of outcome of vitreous surgery based on vitreous levels of cytokines

AIM: To ascertain whether vitreous and plasma levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and fundus findings could predict the outcome of vitreous surgery in patients with proliferative diabetic retinopathy (PDR). METHODS: Vitreous fluid samples were obtained during vitreoretinal surgery from 73 consecutive eyes with PDR. The levels of VEGF and IL-6 in vitreous fluid and plasma were determined by enzyme-linked immunosorbent assay. Patients were prospectively followed for 6 months and the postoperative outcome was analysed by logistic regression analysis. RESULTS: No improvement and/or progression of PDR occurred in 23 (32%) of the 73 eyes (progression group). The vitreous levels of VEGF and IL-6 were significantly higher in eyes from the progression group than in eyes with regression of PDR (regression group) (P=0.0032 and 0.0088, respectively). Multivariate logistic regression analysis showed that higher vitreous levels of VEGF were associated with the progression of PDR after vitreous surgery (odds ratio 2.72, P=0.0003). CONCLUSIONS: High vitreous levels of VEGF identified as a significant risk factor for the outcome of vitreous surgery in patients with PDR. A model was developed to predict the probability of PDR progression and measurement of the vitreous level of VEGF may be useful for predicting the outcome of surgery.     

增殖性糖尿病视网膜病变玻璃体SDF-1和VEGF的含量分析

研究增殖性糖尿病视网膜病变患者玻璃体基质细胞衍生因子（Stromalcell—derivedfactor-1。SDF-1）和血管内皮生长因子（Vascularendothelialgrowthfactor，VEGF）的浓度，及其相互作用关系。方法：酶联免疫吸附法（Enzyme-linkedimmunosorbentassay，ELISA）检测玻璃体内SDF-1和VEGF的含量，每个标本重复3次。实验组为增殖性糖尿病视网膜病变（Proliferativediabeticretinopathy，PDR）的住院患者30例，对照组为同期行玻璃体切除术的特发性黄斑裂孔患者12例。结果：PDR患者玻璃体VEGF的平均浓度为（2865．87±387．85）pg／ml，明显高于特发性黄斑裂孔组[（142．42±21．03）pg／ml，P〈0．0001]。增殖性糖尿病视网膜病变患者玻璃体SDF-1的含量平均为（298．40±24．57）pg／ml，对照组为（86．9l±15．89）pg／ml，两组的差异具有统计学意义（P〈0．0001）。在30例PDR患者玻璃体内VEGF和SDF-1的含量表现为正相关（Pearson相关系数r=0．62，P〈0．001）。结论：增殖性糖尿病患者玻璃体SDF-1和VEGF的含量均高于非糖尿病患者，提示SDF-1和VEGF共同参与了增殖性糖尿病视网膜病变患者病理性新生血管的形成过程。     

Outcome of vitreous surgery and the balance between vascular endothelial growth factor and endostatin

PURPOSE: To predict the results of vitreous surgery in patients with proliferative diabetic retinopathy (PDR), the correlation between vitreous fluid levels of vascular endothelial growth factor (VEGF) or endostatin and the postoperative outcome was investigated. METHODS: VEGF and endostatin levels in vitreous fluid specimens obtained during vitreous surgery were measured by enzyme-linked immunosorbent assay. Expression of VEGF and endostatin in epiretinal membranes was assessed immunohistochemically. Patients were prospectively followed up for 6 months. RESULTS: No improvement and/or progression of PDR was seen in 11 (25%) of 44 eyes (progression group). The vitreous fluid level of VEGF was significantly higher in the progression group than in the regression group (P = 0.0023). Conversely, the vitreous fluid level of endostatin was significantly higher in the regression group than in the progression group (P = 0.0299). Eyes with a high vitreous fluid level of VEGF and a low endostatin level had a significantly greater risk of progression of PDR after vitreous surgery than did eyes with low VEGF and high endostatin levels (odds ratio = 10.00, P = 0.047). VEGF and endostatin were detected immunohistochemically in the fibrovascular epiretinal membranes resected from the subjects. CONCLUSIONS: In this study both VEGF and endostatin were expressed in eyes with PDR. VEGF and endostatin levels in the vitreous fluid correlated with the outcome of vitreous surgery for PDR. Therefore, the outcome of PDR surgery can probably be predicted by measuring cytokines and/or growth factors in the vitreous fluid, with VEGF and endostatin being good candidates.     

Vitreous levels of angiopoietin 2 and vascular endothelial growth factor in patients with proliferative diabetic retinopathy

PURPOSE: To investigate the levels of angiopoietin-2 (Ang2) and vascular endothelial growth factor (VEGF) in the vitreous fluids of patients with proliferative diabetic retinopathy (PDR) and to ascertain their involvement, if any, in angiogenesis of PDR. DESIGN: Retrospective case-control study. METHODS: Forty-one eyes of 41 patients with proliferative diabetic retinopathy and 18 eyes of 18 patients with nondiabetic ocular diseases (control group). Nondiabetic control eyes included 11 with idiopathic macular hole and 7 with idiopathic epiretinal membrane. Vitreous fluid samples were obtained at vitrectomy, and the levels of Ang2 and VEGF were measured by enzyme-linked immunosorbent assay. RESULTS: Vitreous level (mean +/- SD) of Ang2 was significantly higher in patients with PDR (1,753 +/- 3,213 pg/ml) than in control patients (112 +/- 113 pg/ml) (P < .0001). The vitreous concentration of VEGF was also significantly higher in patients with PDR (812 +/- 1,108 pg/ml) than in control patients (1.7 +/- 4.4 pg/ml) (P < .0001). Both Ang2 and VEGF levels in eyes with active PDR were significantly higher than in those with inactive PDR. The vitreous concentration of Ang2 correlated significantly with that of VEGF in eyes with proliferative diabetic retinopathy ([correlation coefficient] rho = 0.497, P = .001). CONCLUSIONS: These data demonstrate an increase of Ang2 in the vitreous fluid of patients with PDR and suggest an association of Ang2 and VEGF with angiogenic activity in PDR.     

2型糖尿病患者增生性糖尿病视网膜病变玻璃体切割术后玻璃体再积血原因分析

背景 玻璃体切割术是治疗2型糖尿病患者增生性糖尿病视网膜病变（PDR）的有效方法,但术后再次出现玻璃体积血是导致患者视力再次下降的主要原因之一.目的 分析2型糖尿病PDR患者行玻璃体切割术后玻璃体再积血的相关因素,探讨其预防及处理方法.方法 采用系列病例回顾性研究的方法,收集2006年2月至2012年12月在首都医科大学宣武医院及北京同仁医院接受玻璃体切割术的305例2型糖尿病PDR患者305例305眼的临床资料,对其中14例14眼术后发生玻璃体积血的原因、表现和治疗效果进行分析.结果 305例糖尿病PDR患者接受玻璃体切割术后发生玻璃体积血者14例,发生率为4.6％,其中3例眼底病变为PDRⅣ期,4例为Ⅴ期,7例为Ⅵ期.14眼均经标准睫状体切口玻璃体切割术,术中均给予眼内激光光凝,1眼行巩膜外冷凝术,8眼行玻璃体腔内硅油填充.首次玻璃体切割术后6眼视力提高,4眼术后视力无改变,4眼视力较术前下降.术后再次出现玻璃体积血的时间为术后1～7d者9眼,术后8d～3个月者1眼,术后3～6个月者2眼,术后6个月以上者2眼.玻璃体再积血的原因主要为新生血管膜残留、激光光凝范围和强度不足、新生血管形成及血糖浓度不稳定.5眼药物治疗后玻璃体积血吸收,9眼再次行玻璃体手术.最终9眼视力提高,2眼视力不变,3眼视力下降;13眼患眼视网膜复位,1眼硅油填充术后视网膜仍未复位.结论 PDR行玻璃体切割术后玻璃体再积血多发生于术后1周内,与视网膜新生血管残留、眼内激光光凝不充分及血糖水平控制欠佳有关.出血量较少的患者玻璃体积血可以自行吸收或可行药物治疗,出血量较大且持续不吸收的患者需要再次行玻璃体切割术.     

Association of preoperative vitreous IL‐8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy

Acta Ophthalmol. 2010: 88: e311–e316

Abstract.

Purpose: To determine whether the vitreous levels of interleukin 8 (IL‐8) and vascular endothelial growth factor (VEGF) of patients with proliferative diabetic retinopathy (PDR) were associated with poor visual acuity after vitrectomy. Methods: Observational cross‐sectional study. Patient clinical characteristics and preoperative eye characteristics (63 eyes): visual acuity, iris neovascularization, vitreous haemorrhage, macular detachment, macular oedema, active retinal neovascularization, neovascularization of the disc, burned out PDR (defined as natural end stage of PDR with inactive membranes without previously performed laser photocoagulation) and panretinal photocoagulation were registered prior to vitrectomy for each patient. Vitreous VEGF and IL‐8 levels were measured using the cytometric bead array method. Poor postoperative visual acuity was defined as visual acuity of <20/200 and was checked 2 years after vitrectomy. Results: Twenty‐one of the 63 eyes (33.3%) had poor visual acuity after vitrectomy. Univariate analysis showed that vitreous levels of IL‐8, the absence of panretinal photocoagulation, preoperative macular detachment and poor preoperative visual acuity were significantly associated with poor final visual acuity after vitrectomy. A stepwise multiple logistic regression analysis showed that elevated vitreous levels of IL‐8 (p < 0.0001), macular detachment (p = 0.011) and the absence of panretinal photocoagulation (p = 0.03) were independent predictors for poor visual outcome. Conclusions: Elevated vitreous IL‐8 level could either be a marker of ischaemic inflammatory reaction, or it could play a role in deteriorating visual acuity by DR progression or both. Further studies are needed to provide better understanding of IL‐8 and inflammation involvement in visual prognosis in PDR.     

Correlation between angiotensin-converting enzyme, vascular endothelial growth factor, and matrix metalloproteinase-9 in the vitreous of eyes with diabetic retinopathy

PURPOSE: To investigate the involvement of angiotensin-converting enzyme (ACE) with angiogenic factors, vascular endothelial growth factor (VEGF), and matrix metalloproteinase (MMP)-9 in the vitreous of eyes with proliferative diabetic retinopathy (PDR). DESIGN: Observational case series. METHODS: Angiotensin-converting enzyme activity in the vitreous was measured by using a synthetic substrate for ACE. VEGF and MMP-9 concentrations were determined by enzyme-linked immunosorbent assay. RESULTS: Vitreous ACE activity was significantly higher in eyes with PDR (1.4 +/- 1.3 mU/ml) than in eyes with macular holes (0.22 +/- 0.11 mU/ml). Vitreous VEGF concentration in the eyes with PDR (1067 +/- 1076 pg/ml) was significantly higher than in eyes with macular holes (34 +/- 5.5 pg/ml). Vitreous MMP-9 concentration was also significantly higher in eyes with PDR (7.5 +/- 3.8 ng/ml) than in eyes with macular holes (4.2 +/- 1.4 ng/ml). Significant correlations between ACE and VEGF (P < .01) and between ACE and MMP-9 (P < .01) were observed in the vitreous of eyes with PDR. CONCLUSIONS: Angiotensin-converting enzyme was significantly correlated with angiogenic factors, VEGF and MMP-9, in the vitreous of eyes with PDR.     

Angiotensin II and vascular endothelial growth factor in the vitreous fluid of patients with proliferative diabetic retinopathy

AIMS: To investigate the correlation between the level of angiotensin II and vascular endothelial growth factor (VEGF) in the vitreous fluid and the severity of proliferative diabetic retinopathy (PDR). METHODS: During vitreoretinal surgery at the Tokyo Women's Medical University, vitreous fluid samples were obtained from 51 eyes of diabetic patients with PDR, six eyes of diabetic patients without retinopathy, and 16 eyes of non-diabetic patients with ocular disease (controls). The VEGF levels in vitreous fluid and plasma were determined by enzyme linked immunosorbent assay, while angiotensin II levels were measured by radioimmunoassay. RESULTS: The vitreous fluid levels of VEGF and angiotensin II were significantly higher in patients with PDR than in non-diabetic patients or diabetic patients without retinopathy (all p<0.0001). The vitreous fluid level of angiotensin II was significantly correlated with that of VEGF (p<0.0001), and the vitreous concentrations of both VEGF and angiotensin II were significantly higher in patients with active PDR than in those with quiescent PDR (p<0.0001 and p=0.0005, respectively). CONCLUSION: The authors found that both angiotensin II and VEGF levels were significantly higher in the vitreous fluid of patients with PDR than in that of non-diabetic patients or diabetic patients without retinopathy, and that the levels of both angiotensin II and VEGF were elevated in the active stage of PDR. These findings suggest that angiotensin II contributes to the development and progression of PDR in combination with VEGF.     

Elevated Vascular Endothelial Growth Factor Levels in the Vitreous of Patients With Proliferative Diabetic Retinopath

Objective: To detect the levels of vascular endothelial growth factor (VEGF) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to investigate the possible role of VEGF in the development of neovascularization in PDR. Methods ; Undiluted vitreous samples and fasting venous blood samples were obtained from 27 patients with PDR and 14 subjects with idiopathic macular hole who underwent pars plana vitrectomy. The concentration of VEGF was determined by quantitative enzyme - linked immunosorbent assay (ELISA).Results: The level of vitreous VEGF in patients with PDR (median 0. 41ng/ml, range 0. 09- 11. 56ng/ml) was significantly elevated when compared with that in control subjects (median 0.017ng/ml, range 0.008-0.04ng/ml)(P<0. 001). The median of PDR patients' serum VEGF concentration was 0.19ng/ml (0. 090. 46ng/ ml) which was far lower than vitreous VEGF concentration (P<0. 05). Vitreous VEGF concentration was higher in PDR patients with retinal detachment than that in patient wi