title: Vascular endothelial growth factor in a recipient cornea acts as a prognostic factor for corneal graft reaction development.
abstract: OBJECTIVE
  To evaluate whether the vascular endothelial growth factor A (VEGF-A) in the recipient cornea measured at the time of penetrating keratoplasty (PK) can act as a prognostic factor for corneal graft reaction development.
  
  
  METHODS
  The study included 25 eyes (of 25 patients) scheduled for PK. According to preoperative clinical finding, patients were divided into three groups: inflammatory with neovascularization (n = 11); inflammatory without neovascularization (n = 7); and non-inflammatory (n = 7). One half of the recipient cornea was analyzed for the levels of VEGF-A protein using a commercial enzyme-linked immunosorbent assay; the other half was analyzed to determine the loci of VEGF-A production by immunohistochemistry. The frequencies of corneal graft reaction and rejection were recorded, together with the improvement of visual acuity. Twenty-five donor corneas obtained from cadaver eyes represented the control group (n = 25).
  
  
  RESULTS
  There was a statistically significant difference in the levels of VEGF-A protein between the recipient corneal buttons obtained from eyes with inflammatory changes and neovascularization, and those from the non-inflammatory group and controls (p < 0.01). The level of VEGF-A was 287.74 pg/ml (standard deviation [SD] = 129.181) in the inflammatory with corneal neovascularization group, 227.64 pg/ml (SD = 85.590) in the inflammatory without neovascularization group, 115.37 pg/ml (SD = 105.93) in the non-inflammatory group, and 142.28 pg/ml (SD = 93.081) in the control group. Graft reaction/rejection rate was 54.5%/45.5% in the inflammatory with neovascularization group, 14.3%/0% in the inflammatory without neovascularization group, and 14.3%/14.3% in non-inflammatory group. Patients who developed clinical signs of graft reaction during the postoperative follow-up had a significantly higher level of VEGF-A (307.4 pg/ml, SD = 100.058) compared with those without any signs of graft reaction (182.8 pg/ml, SD = 124.987).
  
  
  CONCLUSIONS
  Our results suggest that both graft reaction and final graft rejection occur more often in patients with increased levels of VEGF-A in a recipient cornea at the time of PK.
authors.affiliation: Eye Department, General Hospital "Dr. J. Bencevic" , Slavonski Brod , Croatia .
authors.forename: Sandra
authors.initials: S
authors.lastname: Sekelj
authors.forename: Iva
authors.initials: I
authors.lastname: Dekaris
authors.forename: Tihomir
authors.initials: T
authors.lastname: Balog
authors.forename: Ivana
authors.initials: I
authors.lastname: Mahovne
authors.forename: Edita Kondza
authors.initials: EK
authors.lastname: Krstonijevic
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Janjetovic
authors.forename: Zeljka Vukovic
authors.initials: ZV
authors.lastname: Arar
authors.forename: Ivana
authors.initials: I
authors.lastname: Aric
mesh_terms: D003315:Cornea / Q000378:metabolism*; D003316:Corneal Diseases / Q000601:surgery*; D016510:Corneal Neovascularization / Q000175:diagnosis / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D007150:Immunohistochemistry; D015948:Keratoplasty, Penetrating; D011379:Prognosis; D066027:Transplant Recipients; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*; D014792:Visual Acuity / Q000502:physiology
chemical_list: C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
keywords: ELISA; graft rejection; immunohistochemistry; penetrating keratoplasty; vascular endothelial growth factor