Aqueous Humor Levels of Vascular Endothelial Growth Factor and Pigment Epithelium–Derived Factor in Polypoidal Choroidal Vasculopathy and Choroidal Neovascularization

doi:10.1016/j.ajo.2005.10.012

American Journal of Ophthalmology

Volume 141, Issue 3, March 2006, Pages 456-462

https://doi.org/10.1016/j.ajo.2005.10.012 Get rights and content

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.

Section snippets

Methods

This comparative control study investigated the levels of VEGF and PEDF in aqueous humors in patients with active PCV and CNV secondary to AMD and pathologic myopia. Aqueous samples from senile cataract patients without other ocular or systemic diseases were collected as controls. The study protocol complied with the provisions of the Declaration of Helsinki and was reviewed and approved by the Ethics Committee of the Chinese University of Hong Kong. Informed consent was obtained from each

Results

A total of 42 aqueous humor samples from 32 diseased patients and 10 controls were collected; all participants were Chinese. No statistically significant differences were found among the mean ages in the PCV (mean ± SD; 67.1 ± 8.4 years, range 52 to 83 years), AMD (72.5 ± 5.8 years, range 67 to 84 years), and cataract control (73.0 ± 7.5 years, range 61 to 84) groups. However, the mean age of patients with myopia was younger (44.4 ± 13.8 years, range 22 to 68 years) than the other groups (Table

Discussion

CNV secondary to AMD and pathologic myopia are important causes of visual impairments and legal blindness in the elderly and in middle-aged adults.22, 23 With the advent of more advanced ophthalmic imaging systems, newer descriptions and patterns of exudative maculopathy have been recognized.⁷

PCV is one of exudative maculopathy and has distinct dilated, aneurysmal, polyplike structures as reddish-orange lesions in the fundus examination. The choroidal abnormalities, including polyplike

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Myopic choroidal neovascularization (CNV) is a vision-threatening complication of high myopia. Here, we systematically review cohort, case-control, and cross-sectional studies in PubMed, Embase, and Web of Science, and summarize the associated factors of myopic CNV using meta-analysis where applicable. Among 1,333 records assessed, 50 were found eligible, all having a low-to-moderate risk of bias. Highly myopic eyes with CNV had a higher risk of lacquer cracks (odds ratio = 2.88) and patchy chorioretinal atrophy (odds ratio = 3.43) than those without. The mean posterior staphyloma height (µm) was greater in myopic CNV eyes than in highly myopic eyes without CNV (mean difference = 82.03). The thinning of choroidal thickness (µm) between myopic eyes with and without CNV differed significantly (mean difference = −47.76). The level of vascular endothelial growth factor (pg/ml) in the aqueous humor of myopic CNV eyes was significantly higher than in highly myopic eyes without CNV (mean difference = 24.98), the same as interleukin-8 (IL-8) (pg/ml, mean difference = 7.73). Single-nucleotide polymorphisms in the vascular endothelial growth factor, complement factor I, and collagen type VIII alpha 1 genes were associated with myopic CNV. We found that myopic CNV eyes have a higher ratio of lacquer cracks and patchy chorioretinal atrophy, thinner choroid, greater posterior staphyloma height, and a higher level of vascular endothelial growth factor and IL-8 in aqueous. Structural predisposing lesions, hemodynamic, genetic, and systemic factors are also associated with myopic CNV.
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: Supported in part by Competitive Earmarked Research (4140/02M), Research Grant Council, Hong Kong.

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Original articleAqueous Humor Levels of Vascular Endothelial Growth Factor and Pigment Epithelium–Derived Factor in Polypoidal Choroidal Vasculopathy and Choroidal Neovascularization

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Ophthalmol

Ophthalmology

Prog Retin Eye Res

Am J Ophthalmol

Ophthalmology

Prog Retin Eye Res

Am J Ophthalmol

FEBS Lett

Biochem Biophys Res Commun

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Idiopathic polypoidal choroidal vasculopathy (IPCV)

Retina

Polypoidal choroidal vasculopathy in exudative and haemorrhagic pigment epithelial detachments

Br J Ophthalmol

Polypoidal choroidal vasculopathy in Chinese patients

Br J Ophthalmol

Polypoidal choroidal vasculopathy in Caucasians

Graefes Arch Clin Exp Ophthalmol

The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy

Arch Ophthalmol

Indocyanine green videoangiography of idiopathic choroidal vasculopathy

Retina

Inhibitors of ocular neovascularizationpromises and potential problems

JAMA

Growth factor localization in choroidal neovascular membranes of age-related macular degeneration

Invest Ophthalmol Vis Sci

VEGF is major stimulator in model of choroidal neovascularization

Invest Ophthalmol Vis Sci

Original article
Aqueous Humor Levels of Vascular Endothelial Growth Factor and Pigment Epithelium–Derived Factor in Polypoidal Choroidal Vasculopathy and Choroidal Neovascularization