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Original Article
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Volume 331:1480-1487 December 1, 1994 Number 22
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Vascular Endothelial Growth Factor in Ocular Fluid of Patients with Diabetic Retinopathy and Other Retinal Disorders
Lloyd Paul Aiello, Robert L. Avery, Paul G. Arrigg, Bruce A. Keyt, Henry D. Jampel, Sabera T. Shah, Louis R. Pasquale, Hagen Thieme, Mami A. Iwamoto, John E. Park, Hung V. Nguyen, Lloyd M. Aiello, Napoleone Ferrara, and George L. King

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ABSTRACT

Background Retinal ischemia induces intraocular neovascularization, which often leads to glaucoma, vitreous hemorrhage, and retinal detachment, presumably by stimulating the release of angiogenic molecules. Vascular endothelial growth factor (VEGF) is an endothelial-cell-specific angiogenic factor whose production is increased by hypoxia.

Methods We measured the concentration of VEGF in 210 specimens of ocular fluid obtained from 164 patients undergoing intraocular surgery, using both radioimmunoassays and radioreceptor assays. Vitreous proliferative potential was measured with in vitro assays of the growth of retinal endothelial cells and with VEGF-neutralizing antibody.

Results VEGF was detected in 69 of 136 ocular-fluid samples from patients with diabetic retinopathy, 29 of 38 samples from patients with neovascularization of the iris, and 3 of 4 samples from patients with ischemic occlusion of the central retinal vein, as compared with 2 of 31 samples from patients with no neovascular disorders (P<0.001, P<0.001, and P = 0.006, respectively). The mean (±SD) VEGF concentration in 70 samples of ocular fluid from patients with active proliferative diabetic retinopathy (3.6 ±6.3 ng per milliliter) was higher than that in 25 samples from patients with nonproliferative diabetic retinopathy (0.1 ±0.1 ng per milliliter, P = 0.008), 41 samples from patients with quiescent proliferative diabetic retinopathy (0.2 ±0.6 ng per milliliter, P<0.001), or 31 samples from nondiabetic patients (0.1 ±0.2 ng per milliliter, P = 0.003). Concentrations of VEGF in vitreous fluid (8.8 ±9.9 ng per milliliter) were higher than those in aqueous fluid (5.6 ±8.6 ng per milliliter, P = 0.033) in all 10 pairs of samples obtained simultaneously from the same patient; VEGF concentrations in vitreous fluid declined after successful laser photocoagulation. VEGF stimulated the growth of retinal endothelial cells in vitro, as did vitreous fluid containing measurable VEGF. Stimulation was inhibited by VEGF-neutralizing antibodies.

Conclusions Our data suggest that VEGF plays a major part in mediating active intraocular neovascularization in patients with ischemic retinal diseases, such as diabetic retinopathy and retinal-vein occlusion.


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From the Department of Ophthalmology, Beetham Eye Institute (L.P.A., P.G.A., S.T.S., L.M.A.), and the Division of Research (L.P.A., H.T., G.L.K.), Joslin Diabetes Center; the Departments of Medicine and Ophthalmology, Brigham and Women's Hospital (L.R.P., M.A.I., G.L.K.); and Harvard Medical School (L.P.A., P.G.A., S.T.S., L.R.P., H.T., M.A.I., L.M.A., G.L.K.) -- all in Boston; the Neuroscience Research Institute, University of California, Santa Barbara (R.L.A.); Genentech, Inc., San Francisco (B.A.K., J.E.P., H.V.N., N.F.); and the Department of Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore (H.D.J.).

Address reprint requests to Dr. L.P. Aiello at the Beetham Eye Institute, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215.

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