Wakabayashi Yoshihiro, Usui Yoshihiko, Tsubota Kinya, Ueda Shunichiro, Umazume Kazuhiko, Muramatsu Daisuke, Goto Hiroshi
Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan.
Retina. 2017 Dec;37(12):2317-2325. doi: 10.1097/IAE.0000000000001490.
The purpose of this study was to investigate whether vitreous levels of vascular endothelial growth factor (VEGF) predict late vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy, and how VEGF level changes in patients with postoperative late VH.
Eighty-five eyes of 68 patients with proliferative diabetic retinopathy who underwent vitrectomy were analyzed retrospectively. Vitreous samples were collected from eyes undergoing primary vitrectomy and from eyes with late VH undergoing second vitrectomy. Vitreous VEGF levels were measured using enzyme-linked immunosorbent assay. The relationship between VEGF level and late VH (>4 weeks) occurring during follow-up as well as clinical findings, and changes in VEGF level in eyes with late VH undergoing second vitrectomy were analyzed.
Late VH occurred in 20 (24%) of 85 eyes, and 9 eyes required second vitrectomy. Vitreous levels of VEGF were significantly higher (median: 1,945 pg/mL; P < 0.0001) in eyes with late VH than in those without. Preexisting iris neovascularization (P < 0.0001), hypertension (P = 0.002), and proteinuria (P = 0.040) were also significant risk factors of late VH. Multivariate logistic regression analysis showed that a higher vitreous VEGF level was independently associated with a risk of postoperative late VH in patients with proliferative diabetic retinopathy (odds ratio: 20.8, 95% confidence interval: 2.72-159.47; P = 0.003). Vitreous VEGF level at second vitrectomy in patients with late VH was significantly lower compared with that at primary vitrectomy, but remained elevated (median: 1,610 pg/mL; P = 0.023).
In patients with proliferative diabetic retinopathy, high intraocular VEGF level at primary vitrectomy was identified as an independent risk factor of postoperative late VH. Persistent overproduction of intraocular VEGF may be associated with postoperative late VH.
本研究旨在探讨血管内皮生长因子（VEGF）的玻璃体水平是否可预测增殖性糖尿病视网膜病变玻璃体切除术后晚期玻璃体出血（VH），以及术后晚期VH患者的VEGF水平如何变化。
回顾性分析68例接受玻璃体切除术的增殖性糖尿病视网膜病变患者的85只眼。从接受初次玻璃体切除术的眼以及接受二次玻璃体切除术的晚期VH眼中采集玻璃体样本。使用酶联免疫吸附测定法测量玻璃体VEGF水平。分析VEGF水平与随访期间发生的晚期VH（>4周）之间的关系以及临床发现，以及接受二次玻璃体切除术的晚期VH眼的VEGF水平变化。
85只眼中有20只（24%）发生晚期VH，9只眼需要二次玻璃体切除术。晚期VH眼的玻璃体VEGF水平显著高于无晚期VH的眼（中位数：1945 pg/mL；P<0.0001）。既往虹膜新生血管形成（P<0.0001）、高血压（P = 0.002）和蛋白尿（P = 0.040）也是晚期VH的显著危险因素。多因素逻辑回归分析显示，较高的玻璃体VEGF水平与增殖性糖尿病视网膜病变患者术后晚期VH的风险独立相关（优势比：20.8，95%置信区间：2.72 - 159.47；P = 0.003）。晚期VH患者二次玻璃体切除时的玻璃体VEGF水平与初次玻璃体切除时相比显著降低，但仍升高（中位数：1610 pg/mL；P = 0.023）。
在增殖性糖尿病视网膜病变患者中，初次玻璃体切除时眼内VEGF水平高被确定为术后晚期VH的独立危险因素。眼内VEGF持续过度产生可能与术后晚期VH有关。
