Vegf (in Situ Macular Edema & Uveitis

眼内和全身血管生成因子血管内皮生长因子（VEGF）水平升高与眼部新血管生长有关，如糖尿病视网膜病变。最近使用免疫病理学技术的研究表明，VEGF在实验诱导的葡萄膜炎和葡萄膜炎眼睛中都是上调的，没有新血管形成的证据。这项初步研究评估了伴有和不伴有囊样黄斑水肿的葡萄膜患者血液中VEGF的水平。在接受眼科手术的患者的眼液中也测定了这一水平。我们测量了20例葡萄膜炎患者（9例有CME， 11例无CME）房水中的VEGF浓度，以及40例葡萄膜炎患者（20例有CME， 20例无CME）和20名健康志愿者血浆中的VEGF浓度。结果：伴有和不伴有CME的葡萄膜炎患者房水中VEGF的平均浓度分别为152.3和109.5 pg/mL, p=0.048。伴有和不伴有CME的葡萄膜炎患者以及健康志愿者的平均血浆VEGF浓度分别为32.2、29.6和55.0 pg/mL。葡萄膜炎患者血浆VEGF水平低于健康志愿者，p=0.002。结论：葡萄膜炎伴CME患者房水中VEGF浓度升高。全身免疫抑制的葡萄膜炎患者血浆VEGF浓度降低。由于这些观察结果，我们已经开始测试？？-生育酚（维生素E），一种有效的蛋白质抑制剂

Increased intraocular and systemic levels of the angiogenic factor vascular endothelial growth factor (VEGF) is associated with new vessel growth in the eye, such as diabetic retinopathy. Recent work using immunopathologic techniques have shown that VEGF is upregulated in both experimentally induced uveitis and in uveitis eyes as well, with no evidence of neovascularization. This pilot study evaluated the level of VEGF in the blood of uveitic patients with and without cystoid macular edema. This level was determined also in the ocular fluid of those patietns undergoing ocular surgery. We measured the VEGF concentration in the aqueous humor of 20 uveitis patients (9 with and 11 without CME), and in the plasma of 40 uveitis patients (20 with and 20 without CME) and 20 healthy volunteers. Results: Mean aqueous humor VEGF concentrations for uveitis patients with and without CME were 152.3 and 109.5 pg/mL, p=0.048. Mean plasma VEGF concentrations in uveitis patients with and without CME and in healthy volunteers were 32.2, 29.6, and 55.0 pg/mL. Uveitis patients had lower plasma VEGF levels than healthy volunteers, p=0.002. Conclusions: VEGF concentration is elevated in the aqueous humor of uveitis patients with CME. Plasma VEGF concentration is reduced in uveitis patients on systemic immunosuppression. Because of these observations, we have begun testing the efficacy of ???-tocopherol (vitamin E), a potent inhibitor of the protein kinase C pathway in vascular endothelial growth factor (VEGF) induced vascular permeability, for the treatment of uveitis-associated macular edema. This is performed using a double-masked, randomized study in which uveitis patients with macular edema will receive either ???-tocopherol or placebo. Patients will receive 1600IU/day of Vitamin E or placebo for 4 months. The primary outcome will be a visual acuity increase of 10 letters or more from baseline to month 4. Secondary outcomes are total area of leakage and macular height as determined by fluorescein angiography, changes in CME as measured by stereoscopic color photographs, optical coherence tomography (OCT), the need for periocular injections or additional systemic immunomodulatory medications, and the NEI VFQ summary score.