Short-term effect of intravitreal ranibizumab on intraocular concentrations of vascular endothelial growth factor-A and pigment epithelium-derived factor in neovascular glaucoma

Clin Exp Ophthalmol. 2015 Jul;43(5):415-21. doi: 10.1111/ceo.12477. Epub 2015 Jan 14.

Abstract

Background: This study aims to evaluate concentrations of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF)-A in aqueous of patients with neovascular glaucoma prior to, and shortly after, an intravitreal ranibizumab injection.

Design: Interventional comparative study.

Participants: The study included patients undergoing an intravitreal ranibizumab injection about one week before anti-glaucomatous surgery (study group) or who underwent routine cataract surgery (control group).

Methods: Aqueous and blood samples were collected at the occasions of intravitreal injections, anti-glaucomatous surgery or cataract surgery. They were analysed by enzyme-linked immunosorbent assay.

Main outcome measures: Concentrations of PEDF and VEGF-A in aqueous.

Results: At baseline, concentrations VEGF-A (3698 ± 2105 pg/mL vs. 233 ± 98 pg/mL) and PEDF (18.9 ± 11.9 ug/mL vs. 2.2 ± 0.6 ug/mL) were higher (P < 0.001) in the study group (n = 20 patients) than control group (n = 20 patients). The VEGF-A/PEDF concentration ratio was higher in the study group (396 ± 554 vs. 110 ± 49; P = 0.02). One week after the ranibizumab injection, iris neovascularization had completely regressed in 17 (85%) eyes, and VEGF-A concentration decreased significantly (P < 0.001) to 184 ± 130 pg/mL. The PEDF concentration remained unchanged (19 ± 12 ug/mL). The VEGF-A/PEDF concentration ratio decreased to 13.2 ± 13.6. Plasma concentrations of VEGF-A and PEDF did not differ significantly between both groups (P = 0.65 and P = 0.15, respectively) nor were they significantly correlated with the aqueous concentrations (all P > 0.15).

Conclusions: Aqueous concentrations of VEGF-A and PEDF were significantly elevated in eyes with neovascular glaucoma. Within one week after intravitreal injection of ranibizumab, VEGF-A concentration decreased to subnormal levels, while the PEDF concentration remained unchanged and the VEGF-A/PEDF ratio decreased.

Keywords: intravitreal ranibizumab; neovascular glaucoma; pigment epithelium derived factor; vascular endothelial growth factor-A.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angiogenesis Inhibitors / therapeutic use*
  • Aqueous Humor / metabolism*
  • Enzyme-Linked Immunosorbent Assay
  • Eye Proteins / metabolism*
  • Female
  • Fluorescein Angiography
  • Glaucoma, Neovascular / drug therapy*
  • Glaucoma, Neovascular / metabolism
  • Humans
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Nerve Growth Factors / metabolism*
  • Prospective Studies
  • Ranibizumab / therapeutic use*
  • Serpins / metabolism*
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Vascular Endothelial Growth Factor A / metabolism*
  • Visual Acuity

Substances

  • Angiogenesis Inhibitors
  • Eye Proteins
  • Nerve Growth Factors
  • Serpins
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • pigment epithelium-derived factor
  • Ranibizumab