Assessment of angiogenic factors activity variation in the prediction of diabetic retinopathy progression after phacoemulsification

Aim. To evaluate the variations of vascular endothelial growth factor and pigment epithelium-derived factor balance as a prognostic factor for diabetic retinopathy progression after phacoemulsification. Methods. The study analyzed 4 samples of tear fluid taken from 2 patients (2 examples per patient). Clinical and functional tests, such as visual acuity test, tonometry, refractometry, visual field test, biomicroscopy, direct ophthalmoscopy, immunoassay, optical coherence tomography, fluorescein angiography, were performed. Clinical and laboratory parameters of homeostasis, including tear concentration of vascular endothelial growth factor and pigment epithelium-derived factor, blood glycosylated hemoglobin level were examined before and after phacoemulsification. Dynamic ophthalmologic control of diabetic retinopathy clinical course was performed. Results. The concentration of pro-angiogenic vascular endothelial growth factor was noted in both cases after the surgery. Hence, in one patient its growth (375 pg/ml before surgery, 467 pg/ml after surgery) exceeded the changes of pigment epithelium-derived factor concentration (2.08 ng/ml before surgery, 1.6 ng/ml after surgery). The progression risk index was estimated as 1.245 for vascular endothelial growth factor and 0.77 for pigment epithelium-derived factor. In second patient, vascular endothelial growth factor also increased after surgery, although, it’s increase (from 335 pg/ml before surgery to 358 pg/ml after surgery) was similar to pigment epithelium-derived factor change (2.15 ng/ml before surgery, 2.02 ng/ml after surgery). The progression risk index in second patient was estimated as 1.07 for vascular endothelial growth factor and 0.94 for pigment epithelium-derived factor. These changes allowed to predict pro-angiogenic potential increase and progression of vascular damage from diabetic retinopathy, in first patient. The second patient had stable balance of pro- and anti-angiogenic factors, allowing to predict a favorable clinical course. Conclusion. The change in vascular endothelial growth factor and pigment epithelium-derived factor ratio over time may be used as a prognostic factor for diabetic retinopathy progression after phacoemulsification.

diabetic retinopathy, angiogenesis, neovascularization, vascular endothelial growth factor, pigment epithelium-derived factor