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)水平的增加与眼内新血管的生长有关，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，在实验诱导的葡萄膜炎和葡萄膜炎眼中，血管内皮生长因子均上调，但没有证据表明有新生血管。这项先导性研究评估了伴有和不伴有黄斑囊样水肿的葡萄膜炎患者血液中血管内皮生长因子的水平。在接受眼科手术的患者的眼液中也检测到了这一水平。我们测定了20例葡萄膜炎患者(9例合并CME，11例不合并CME)房水中、40例葡萄膜炎患者(20例合并CME，20例不合并CME)和20例健康志愿者血浆中的血管内皮生长因子浓度。结果：葡萄膜炎伴和不伴CME患者房水血管内皮生长因子平均浓度分别为152.3和109.5 pg/m L，p=0.048。葡萄膜炎伴和不伴CME患者和健康志愿者的平均血浆VEGF浓度分别为32.2、29.6和55.0pg/ml。葡萄膜炎患者的血浆血管内皮生长因子水平低于健康志愿者，p=0.002。结论：葡萄膜炎合并CME患者房水中血管内皮生长因子浓度升高。葡萄膜炎患者全身免疫抑制时血浆血管内皮生长因子浓度降低。由于这些观察，我们已经开始测试生育酚(维生素E)的有效性，它是一种有效的蛋白质抑制剂 血管内皮生长因子(VEGF)诱导的血管通透性中的激酶C通路，用于治疗葡萄膜炎相关性黄斑水肿。这是通过一项双掩蔽的随机研究进行的，其中伴有黄斑水肿的葡萄膜炎患者将接受生育酚或安慰剂。患者将接受1600IU/天的维生素E或安慰剂，为期4个月。主要结果是从基线到4个月视力提高10个字母或以上。次要结果是通过荧光素血管造影确定的总渗漏面积和黄斑高度，通过立体彩色照片测量的CME的变化，光学相干断层扫描(OCT)，是否需要眼周注射或额外的全身免疫调节药物，以及NEI VFQ总分。

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.