12th Vitreoretinal Symposium Frankfurt – Marburg 2009

Scientific programm: Abstract

6th scientific session: Diabetes / Vein Occlusion

44. Intravitreal Growth Factors in Combined Therapy

Michael J. Koss, M. Pfister, F. Rothweiler,
J. Cinatl, F. H. Koch, M. Michaelis
(Frankfurt am Main)

Purpose: To determine the levels of intravitreal VEGF A, monocytic adhesion protein = MCP, and IL-6 levels in ARMD, DME and RVO with cytometric bead assay technique (CBA).
Methods: Forty-one patients (79.6 years, 21 male) with wet ARMD (split into active, inactive CNV, or PE detachment), 24 with DME (59.4 years, 16 male), 12 with CRVO (70.3 years, 5 male), and 16 with BRVO (73 male, 6 male) respectively, who underwent 0.5 to 1ml core pars plana vitrectomy (cppV) with subsitutition of 1.25mg bevacizumab and 800µg dexamthasone as a first line combined treatment to treat ME. The levels of VEGF, IL-6, and MCP were examined with cytometric bead assay from the aspired vitreous specimen (T1). Retreatment was conducted on clinical relevant increase in CMT and BCVA decrease (T2) in all these cases.
Results: Vitreous VEGF levels in ARMD were 2.7 pg/nl at T1; 9.1 at T2 (T1 to T2 = 22 weeks), in contrast to IL-6 (40.7; 26.0) and MCP (794.5; 762.4) and were partly significantly enhanced in pseudophakic and eyes with PE detachment. In DME vitreous VEGF levels were 159.3 and 151.5 (T1 to T2 = 32 weeks), IL-6 36.0 and 21.8, MCP 281.7 and 159.3. CRVO yielded VEGF levels of 206.2 and 76.8 (T1 to T2 = 34 weeks), IL-6 130.7 and 46.8, MCP 1040.4 and 657.1, whereas BRVO had VEGF of 159.8 and 130.7 (T1 to T2 = 41 weeks), Il-6 of 21.1 and 17.5, and MCP of 575.2 and 513.1.
Conclusion: The cytometric bead assay technique allows for a fast determination of vitreous levels of growth factors that indicate the outbalanced pathogenesis of angiogenesis (VEGF A) and inflammation (Il-6 and MCP). In general we could demonstrate higher vitreous levels (MCP>Il-6>VEGF) in DME and CRVO than in exudative AMD. The combination treatment decreased primarily the inflammatory cytokines from T1 to T2.