Outcome of vitreous surgery and the balance between vascular endothelial growth factor and endostatin.
OBJECTIVE
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.
Funatsu
Hideharu
H
Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan. tfunatsu@nifty.com
Yamashita
Hidetoshi
H
Noma
Hidetaka
H
Mochizuki
Hideki
H
Mimura
Tatsuya
T
Ikeda
Tomohiro
T
Hori
Sadao
S
D000328:Adult; D000368:Aged; D015415:Biomarkers; D003094:Collagen / Q000378:metabolism*; D003930:Diabetic Retinopathy / Q000378:metabolism* / Q000601:surgery*; D043169:Endostatins; D016228:Endothelial Growth Factors / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D019773:Epiretinal Membrane / Q000378:metabolism; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism*; D017075:Laser Coagulation; D008222:Lymphokines / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism*; D011446:Prospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D014821:Vitrectomy; D014822:Vitreous Body / Q000378:metabolism*
D015415:Biomarkers; D043169:Endostatins; D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D008222:Lymphokines; D010446:Peptide Fragments; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D003094:Collagen