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Aqueous Humor and Plasma Levels of Vascular Endothelial Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma. Yonca A . Akova , MD, Mehmet Borazan, MD; Aylin Karalezli, MD; Cem Kucukerdonmez, MD ; Ahmet Akman , MD; Sevsen Kulaksizoglu, MD

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Aqueous Humor and Plasma Levels of Vascular Endothelial Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

Yonca A. Akova, MD, Mehmet Borazan, MD; Aylin Karalezli, MD; CemKucukerdonmez, MD; Ahmet Akman, MD; Sevsen Kulaksizoglu, MD

Baskent University, School of MedicineDepartment of Ophthalmology, Ankara, Turkey


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Financial Interest Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

  • I have received research reimbursement from Alcon andAllergan which  was not relevant to the subject matter of this poster

  • None of the authors have financial interest in the subject matter of this poster


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Introduction Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

  • Pseudoexfoliation syndrome (PXS):

    • Common

    • Age-related

    • May leadto pseudoexfoliative glaucoma (PXG)

    • Specific pathogenetic mechanismand its progression to PXG remain, poorly understood

  • Pseudoexfoliation fibrils:

    • Multifocal

    • Produced by various intraocular cell types


Purpose l.jpg
Purpose Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

To investigate the levels of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in aqueous humor and plasma in eyes with pseudoexfoliationsyndrome (PXS), pseudoexfoliative glaucoma (PXG), and normal controls


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Prospective, randomized clinical study Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

37 patients with PXS

15 patients with PXG

32 control subjects

VEGF levels:

Measured with enzyme-linked immunosorbent assay

NO levels:

Measured withchemiluminescence method (nitrate/nitrite colorimetric assay kit)

Patients and Methods


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P Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucomaseudoexfoliationsyndrome:

Presence of typical pseudoexfoliation material on the anterior lens capsule in one or both eyes

A normal optic disk appearance and visual field testing (Humphrey 30-2 SITA standard test)

IOP < 21 mm Hg

Pseudoexfoliative glaucoma:

IOP > 21 mm Hg

Typical glaucomatous cupping and visual field loss in one or both eyes

Pseudoexfoliative material on the anterior lens capsule

Control group:

Age-and sex-matched patients with cataracts

Absence of any pseudoexfoliation material at the anterior segment of the eye

Patients and Methods


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Aqueous humor samples Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma:

(0.1mL)

Collected at the beginning of, phacoemulsification surgery through a clear corneal paracentesis

Aspirated from the central pupillary area using a 27- gauge needle on a tuberculin syringe

Cooled at – 70C until analyses

Venous blood samples:

(5 mL)

Collected in the fasting state just before patients were prepared for cataract surgery

Stored in chilled tubes containing EDTA (1mg/mL blood) and heparin (100 IU/mL blood)

Centrifuged to obtain plasma

Cooled – 70C until analysis

Patients and Methods


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Pseudoexfoliation Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

Syndrome

(n=37)

Pseudoexfoliation

Glaucoma

(n= 15)

Controls

(n=32)

P value

Age (years)

Range

55-78

53-70

55-80

Mean±SD

72.3 ± 6.3

70.7 ± 8.2

69.6 ± 10.3

0.75

Sex

Male, n(%)

20 (54)

8 (53)

17 (53)

Female, n(%)

17 (46)

7 (47)

15 (47)

0.82

Results


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Pseudoexfoliation Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

Syndrome

(n=37)

Pseudoexfoliation

Glaucoma

(n= 15)

Controls

(n=32)

Aqueous humor

VEGF (µmol/mL)

176.15 ± 55.47*

190.42 ± 46.65*

111.39 ± 18.54

NO (ng/mL)

34.96 ± 16.55$

41.89 ± 21.82#

23.01 ± 12.49

Plasma

VEGF (µmol/mL)

72.82 ± 23.82*

83.70 ± 16.35*

44.08 ± 23.18

NO (ng/mL)

18.89 ± 7.18

20.66 ± 7.69

17.10 ± 5.60

Results

VEGF: vascular endothelial growth factor; NO: nitric oxide

*: P < .001, PXS vs control, PXG vs control

#: P = .001, PXG vs control

$: P < .05, PXS vs control


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Discussion Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

  • Well documented iris vasculopathy, with manifestations of blood aqueous barrier defects, vessel dropout, microneovascularization, hypoperfusion, and anterior chamber hypoxia in PSX1

  • Aqueous humor VEGF levels were found higher in neovascular glaucoma, POAG, angle-closure glaucoma and PXG2,3

  • Controversial findings about aqueous NO levels in glaucoma in the literature4-6

  • Kotikoski et al (only report on the aqueous concentration of NO in eyes with PXG) showed lower NO levels in 6 patients with PXG and 2 patients with PXS compared with controls7

    1. Helbig H, et al.Ger J Ophthalmol 1994;3:148-53

    2. Tripathi RC,et al. Ophthalmology 1998;105:232-237

    3. Hu DN, et al. J Glaucoma 2002;11:406-410

    4. Chang CJ, et al.2000;16:399-406

    5. Galassi F, et al. J Ophthalmol 2004;88:757-760

    6. Kosior-Jarecka E, et al.Klin Oczna 2004;106:158-159

    7. Kotikoski H, et al. Acta Ophthalmol Scand 2002;80:191-195


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Conclusions Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

  • Aqueous humor VEGF and NO levels and plasma VEGF levels in patients with PXS and PXG were found higher than in controls

  • No significant difference was found in plasma NO concentrations compared with controls

  • The aqueous humor and plasma VEGF and NO levels were not significantly different in eyes with PXS compared with PXG

  • Improved understanding of the role of VEGF and NO in the pathogenesis of PXS and related glaucoma may change anti-glaucomatous treatment and anti-VEGF drugs may be an option for these patients


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NAME: Growth Factor and Nitric Oxide in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma Yonca Aydın Akova, M.D.

TITLE: Professor in Ophthalmology

DATE AND PLACE OF BIRTH: October 21, 1960, Turkey

1983: Doctor of Medicine, Istanbul University, School of Medicine

1990: Istanbul University, School of Medicine, Department of Ophthalmology

2000:Professor of Ophthalmology, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey

2002: Chairperson, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey

NAME:Mehmet Borazan, M.D.

TITLE:Fellow in Ophthalmology

DATE AND PLACE OF BIRTH:August 10, 1974, Turkey

1998: Doctor of Medicine, Inonu University, School of Medicine

2005 :Başkent University, School of Medicine, Department of Ophthalmology

NAME:Aylin Karalezli, M.D.

TITLE:Fellow in Ophthalmology

DATE AND PLACE OF BIRTH:July 4, 1974, Turkey

1998: Doctor of Medicine, Ankara University, School of Medicine

2005 :Başkent University, School of Medicine, Department of Ophthalmology

NAME:Cem Küçükerdönmez, M.D.

TITLE:Fellow in Ophthalmology

DATE AND PLACE OF BIRTH:October9, 1975, Turkey

1999: Doctor of Medicine, Hacettepe University, School of Medicine

2003 :Başkent University, School of Medicine, Department of Ophthalmology

NAME:Ahmet Akman, M.D.

TITLE: Professor in Ophthalmology

DATE AND PLACE OF BIRTH:March 20, 1968, Turkey

1991: Doctor of Medicine, Hacettepe University, School of Medicine

1995:Hacettepe University, School of Medicine, Department of Ophthalmology

2007:Professor of Ophthalmology, Baskent University, School of Medicine, Department of Ophthalmology, Ankara, Turkey

NAME: Sevsen Kulasizoglu, M.D

TITLE:Fellow in Biochemistry

DATE AND PLACE OF BIRTH: April 10, 1974, Turkey

1998: Doctor of Medicine, Hacettepe University, School of Medicine

2003 :Başkent University, School of Medicine, Department of Bıochemistry


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