The Association Between Vitreous Vascular Endothelial Growth Factor Levels with Visual Acuity Before and After Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy

Article Sidebar

  PDF
Published Sep 20, 2024
DOI: https://doi.org/10.35479/ijretina.2024.vol007.iss002.257

Main Article Content

I Gusti Agung Ratna Noviantari
Department of Opthalmology, Faculty of Medicine, Udayana University, Indonesia
Ni Made Ari Suryathi
Department of Opthalmology, Faculty of Medicine, Udayana University, Indonesia
A.A. Mas Putrawati Triningrat
Department of Opthalmology, Faculty of Medicine, Udayana University, Indonesia
I Gde Raka Widiana
Faculty of Medicine, Udayana University, Indonesia
Ari Andayani
Department of Opthalmology, Faculty of Medicine, Udayana University, Indonesia
I Wayan Gede Jayanegara
Department of Opthalmology, Faculty of Medicine, Udayana University, Indonesia
Ni Luh Diah Pantjawati
Department of Opthalmology, Faculty of Medicine, Udayana University, Indonesia

Abstract

Introduction: Vascular endothelial growth factor (VEGF) plays a crucial role in the development of proliferative diabetic retinopathy. Elevated levels of VEGF in the vitreous have been found to be associated with the severity of ischemia and neovascularization, which can lead to a decline in visual acuity. This study aims to determine the association between vitreous VEGF levels and improvement in visual acuity before and after PPV in PDR patients.


Methods: This research is an analytic observational study with a pre-post single group design. The subjects of this study were all PDR patients who received PPV therapy at three hospital in Bali Province, Indonesia. Consecutive sampling method were conducted. The independent variable is vitreous VEGF, whilst pre and post-PPV visual acuity is the outcomes. We performed mean comparison and multivariable statistical test using IBM SPSS version 25.


Result: 45 people were included in this study. Improvement in visual acuity after PPV compared to before PPV with an average improvement of 0.54 logMAR (p=0.001). Based on the ANCOVA multivariate analysis, factors affecting visual acuity improvement after PPV were preoperative vision (p<0.001), postoperative vision (p<0.001), HbA1c level (p=0.036), and DM duration (p=0.024). There was no association between high vitreous VEGF levels and visual acuity improvement (PR=0.95; 95% CI=0.55-1.63;p=0.841).


Conclusion: This study concluded that there is an association between PPV and visual acuity improvement. However, clinicians should be aware of several confounding factors that affect visual acuity improvement, including pre-PPV visual acuity, post-PPV visual acuity, duration of DM, and HbA1c level. There is no relationship between vitreous VEGF and visual acuity before and after PPV in PDR, but it is necessary to keep good records of lens status and intraocular pressure status. Further research is needed and the research time is extended to evaluate a better visual outcome.

Keywords

vascular endothelial growth factor, pars plana vitrectomy, proliferative diabetic retinopathy, visual acuity

Article Details

How to Cite
NOVIANTARI, I Gusti Agung Ratna et al. The Association Between Vitreous Vascular Endothelial Growth Factor Levels with Visual Acuity Before and After Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy. International Journal of Retina, [S.l.], v. 7, n. 2, p. 92, sep. 2024. ISSN 2614-8536. Available at: <https://ijretina.com/index.php/ijretina/article/view/257>. Date accessed: 21 dec. 2024. doi: https://doi.org/10.35479/ijretina.2024.vol007.iss002.257.
ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian
Issue
Vol 7 No 2 (2024): International Journal of Retina (IJRetina) - INAVRS
Section
Research Articles
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

References

1. Gupta V, Arevalo JF. Surgical management of diabetic retinopathy. Middle East Afr J Ophthalmol. 2013;20(4):283–92.
2. Sitompul R. Retinopati Diabetik. J Indones Med Assoc. 2011;337–41.
3. Arevalo JF, Lasave A, Zeballos D, Bonofonte-Royo S. Diabetic Retinopathy. SpringerLink. 2013;387–416.
4. Salam A, Mathew R, Sivaprasad S. Treatment of proliferative diabetic retinopathy with anti-VEGF agents. Acta Ophthalmol. 2011;89(5):405–11.
5. Osaadon P, Fagan XJ, Lifshitz T, Levy J. A review of anti-VEGF agents for proliferative diabetic retinopathy. Eye. 2014;28(5):510–20.
6. Wang J, Chen S, Jiang F, You C, Mao C, Yu J, Han J, Zhang Z, Yan H. Vitreous and plasma VEGF levels as predictive factors in the progression of proliferative diabetic retinopathy after vitrectomy. PLoS One. 2014;9(10):1–8.
7. Choovuthayakorn J, Khunsongkiet P, Patikulsila D, Watanachai N, Kunavisarut P, Chaikitmongkol V, Ittipunkul N. Characteristics and Outcomes of Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy Patients in a Limited Resource Tertiary Center over an Eight-Year Period. J Ophthalmol. 2019;2019.
8. Muhiddin HS, Andi MIK, Budu MI. Vitreous and serum concentrations of vascular endothelial growth factor and platelet-derived growth factor in proliferative diabetic retinopathy. Clin Ophthalmol. 2020;14:1547–52.
9. Liao M, Wang X, Yu J, Meng X, Liu Y, Dong X, Li J, Brant R, Huang B, Yan H. Characteristics and outcomes of vitrectomy for proliferative diabetic retinopathy in young versus senior patients. BMC Ophthalmol. 2020;20(1):1–8.
10. Schreur V, Brouwers J, Van Huet RAC, Smeets S, Phan M, Hoyng CB, de Jong EK, Klevering BJ. Long-term outcomes of vitrectomy for proliferative diabetic retinopathy. Acta Ophthalmol. 2021;99(1):83–9.
11. Funatsu R, Terasaki H, Koriyama C, Yamashita T, Shiihara H, Sakamoto T. Silicone oil versus gas tamponade for primary rhegmatogenous retinal detachment treated successfully with a propensity score analysis: Japan Retinal Detachment Registry. Br J Ophthalmol. 2021;(May 2017):1044–50.
12. Sakamoto A, Nishijima K, Kita M, Oh H, Tsujikawa A, Yoshimura N. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefe’s Arch Clin Exp Ophthalmol. 2009;247(10):1325–30.
13. Sharma Y, Pruthi A, Azad R, Kumar A, Mannan R. Impact of early rise of intraocular pressure on visual outcome following diabetic vitrectomy. Indian J Ophthalmol. 2011;59(1):37–40.
14. Petrovič MG, Korošec P, Košnik M, Hawlina M. Association of preoperative vitreous IL-8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy. Acta Ophthalmol. 2010;88(8):311–6.
15. Flaxel CJ, Edwards AR, Aiello LP, Arrigg PG, Beck RW, Bressler NM, Bressler SB, Ferris FL, Gupta SK, Haller JA, Lazarus HS, Qin H. Factors associated with visual acuity outcomes after vitrectomy for diabetic macular edema: diabetic retinopathy clinical research network. Retina. 2010 Oct;30(9):1488–95.
16. Lee S-S, Chang DJ, Kwon JW, Min JW, Jo K, Yoo Y-S, Lyu B, Baek J. Prediction of Visual Outcomes After Diabetic Vitrectomy Using Clinical Factors From Common Data Warehouse. Transl Vis Sci Technol. 2022 Aug;11(8):25.
17. Kumagai K, Furukawa M, Ogino N, Larson E. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Retina. 2010 Jun;30(6):874–80.
18. Shah VA, Brown JS, Mahmoud TH. Correlation of Retinal Thickness and Visual Acuity Following Pars Plana Vitrectomy in Patients With Proliferative Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 2010 Apr 17;51(13):275.
19. Jenkins AJ, Joglekar M V., Hardikar AA, Keech AC, O’Neal DN, Januszewski AS. Biomarkers in diabetic retinopathy. Rev Diabet Stud. 2015;12(1–2):159–95.
20. Kowluru RA, Zhong Q, Kanwar M. Metabolic memory and diabetic retinopathy: Role of inflammatory mediators in retinal pericytes. Exp Eye Res. 2010;90(5):617–23.
21. Maturi R, Glassman A, Josic K, Baker C, Gerstenblith A, Jampol L, Meleth A, Martin D, Melia M, Punjabi O, Rofagha S, Salehi-Had H, Stockdale S, Sun J. Four-Year Visual Outcomes in the Protocol W Randomized Trial of Intravitreus Aflibercept for Prevention of Vision-Threatening Complications of Diabetic Retinopathy. Eur PMC. 2023;376–385.
22. Smith JM, Steel DHW. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2015;2015(8).
23. Ahuja S, Saxena S, Akduman L, Meyer CH, Kruzliak P, Khanna VK. Serum vascular endothelial growth factor is a biomolecular biomarker of severity of diabetic retinopathy. Int J Retin Vitr. 2019;5(1):1–6.
24. Chatziralli I, Loewenstein A. Intravitreal anti-vascular endothelial growth factor agents for the treatment of diabetic retinopathy: A review of the literature. Pharmaceutics. 2021;13(8):1–19.
25. Jahn CE, Von Schütz KT, Richter J, Boller J, Kron M. Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy. Ophthalmologica. 2004;218(6):378–84.