Aqueous Vascular Endothelial Growth Factor as a Predictor of Macular Thickening Following Cataract Surgery in Patients With Diabetes Mellitus

• Published in: American journal of ophthalmology Vol. 148; no. 6; pp. 895 - 901.e1
• Main Authors: Hartnett, M. Elizabeth, Tinkham, Nicholas, Paynter, Lauren, Geisen, Pete, Rosenberg, Pinchas, Koch, Gary, Cohen, Kenneth L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2009; Elsevier; Elsevier Limited
• Subjects: Aged; Aqueous Humor - metabolism; Biological and medical sciences; Cataracts; Cohort Studies; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic Retinopathy - complications; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Enzyme-Linked Immunosorbent Assay; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Insulin-Like Growth Factor I - metabolism; Insulin-like growth factors; Laser Coagulation; Lens diseases; Lens Implantation, Intraocular; Macular Edema - diagnosis; Macular Edema - etiology; Macular Edema - metabolism; Male; Medical sciences; Miscellaneous; Ophthalmology; Phacoemulsification; Pilot Projects; Postoperative Complications; Tomography, Optical Coherence; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - metabolism; Visual Acuity; California; Endocrinopathy; Human; Cataract; Diabetes mellitus; Prediction; Macula; Eye disease; Lens disease; Vascular endothelium growth factor; Treatment; Surgery; Ophthalmology; Anterior segment disease
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2009.07.014

Purpose To study associations between serum and aqueous vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1) and macular edema measured with optical coherence tomography (OCT) following phacoemulsification in diabetic patients. Design Cohort study. Methods A pilot study of 36 consecutive diabetic patients undergoing planned phacoemulsification with IOL in 1 eye by one surgeon at the University of North Carolina consented to preoperative and postoperative OCT central subfield (CSF) thickness measurements and aqueous and blood samples for VEGF and IGF-1. Four patients with clinically significant macular edema (CSME) received laser preoperatively. Spearman-rank correlations were performed between growth factors and mean CSF or a clinically meaningful percent change in CSF (>11% of preoperative measurement) at 1 and 6 months postoperatively. Results There were no surgical complications or new cases of CSME following surgery. Mean aqueous VEGF in patients with retinopathy, determined preoperatively, increased with increasing level of severity. Patients with preoperative CSME also had severe or worse retinopathy and the greatest mean aqueous VEGF. Significant preoperative correlations existed between aqueous VEGF and more severe retinopathy whether CSME was present or absent ( r = 0.49; P = .007), and between aqueous VEGF and CSME ( r = 0.41; P = .029). At 1 month postoperative, aqueous VEGF was positively correlated with >11% change from preoperative CSF regardless of CSME status ( r = 0.47; P = .027). No noteworthy associations existed between CSF and IGF-1 values. Conclusions Aqueous VEGF was significantly positively associated with a clinically meaningful change in CSF in diabetic patients 1 month following cataract surgery. Accounting for preoperative CSF was important. Further study is indicated.