losartan-potassium and Retinal-Perforations

The aim of this study was to evaluate concentrations of erythropoietin (EPO) and vascular endothelial growth factor (VEGF) in serum, aqueous and vitreous humour of diabetic patients with proliferative retinopathy (PDR) and to verify their possible modifications induced by intravitreal injection of bevacizumab (IVB).. This prospective observational study was performed on patients who underwent vitrectomy for proliferative diabetic retinopathy and macular hole or pucker. The study sample consisted of 33 patients with proliferative diabetic retinopathy and 20 non-diabetic patients with macular hole or pucker. EPO and VEGF levels in serum, aqueous and vitreous humour were measured in both groups. In diabetic patients measures were performed before and after IVB.. EPO and VEGF levels in aqueous and vitreous humour were markedly increased in diabetic patients with PDR as compared with those recorded in the control group (P<0.001); contrarily, EPO serum levels were similar in both groups (p=not significant). IVB did not affect EPO levels (aqueous 39.1 ± 29.2 vs. 38.6 ± 26.1; vitreous 179.3 ± 88.3 vs. 131.6 ± 67.8; serum 9.2 ± 5.8 vs. 6.9 ± 3.7 mUI/mL); conversely, VEGF concentration significantly decreased 15 days after IVB in serum and ocular fluids (aqueous 141.6 ± 12.3 vs. 81.4 ± 5.4; vitreous 180.4 ± 45.8 vs. 95.8 ± 23.6; serum 113.9 ± 52.8 vs. 73.2 ± 65.6 mUI/mL).. These findings demonstrate that the production of VEGF and EPO is regulated by different mechanisms. Intraocular levels of EPO in diabetic patients were significantly higher than those recorded in serum, suggesting a local production. In addition, bevacizumab does not influence intraocular levels of EPO.

Topics: Aged; Antibodies, Monoclonal, Humanized; Aqueous Humor; Bevacizumab; Body Fluid Compartments; Comorbidity; Diabetic Retinopathy; Erythropoietin; Female; Humans; Intravitreal Injections; Macular Edema; Male; Middle Aged; Prospective Studies; Retinal Perforations; Serum; Vascular Endothelial Growth Factor A; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Body; Vitreous Hemorrhage

Angiogenesis in diabetic retinopathy (DR) is a multifactorial process regulated by hypoxia-induced growth factors and inflammatory cytokines. In addition to the angiogenic switch, the proteolytic processing and altered synthesis of the extracellular matrix are critical steps in this disease. This study was performed to evaluate the levels of matrix metalloproteinase-2 and matrix metalloproteinase-9 (MMP-2 and MMP-9), angiopoietin-1 and angiopoietin-2 (Ang-1 and Ang-2), vascular endothelial growth factor (VEGF), erythropoietin (EPO) and transforming growth factor-β1 (totalTGFβ1) in the vitreous of diabetic eyes undergoing vitrectomy compared with control eyes operated because of macular hole or pucker.. Prospective consecutive controlled observational study performed in the unit of vitreoretinal surgery in Finland during the years 2006-2008. Vitreous samples were collected before the start of the conventional 3-ppp vitrectomy. Vitreous MMP-2 and MMP-9, Ang-1 and Ang-2, VEGF, EPO and TGFβ1 concentrations were measured from 69 patients with Type 1 or 2 diabetes and 40 controls.. Comparison of eyes with DR with controls revealed that the mean vitreous concentrations of proMMP-2 (p = 0.0015), totalMMP-2 (p = 0.0011), proMMP-9 (p = 0.00001), totalMMP-9 (p < 0.00001), Ang-2 (p < 0.00001), VEGF (p < 0.00001), EPO (p < 0.00001) and totalTGFβ1 (p = 0.000026) were significantly higher in the former group. A multivariate logistic regression analysis suggested intravitreal Ang-2 concentration being the key marker of PDR (p = 0.00025) (OR = 1507.9).. The main new finding is that the intravitreal concentrations of Ang-2 correlated significantly with MMP-9, VEGF, EPO and TGFβ1 levels in diabetic eyes undergoing vitrectomy. Thus, these factors could promote retinal angiogenesis synergistically.

Topics: Aged; Angiopoietin-1; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Enzyme-Linked Immunosorbent Assay; Erythropoietin; Female; Humans; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Middle Aged; Prospective Studies; Retinal Neovascularization; Retinal Perforations; Tomography, Optical Coherence; Transforming Growth Factor beta1; Up-Regulation; Vascular Endothelial Growth Factor A; Vesicular Transport Proteins; Vitrectomy; Vitreous Body

This study compares vitreal levels of erythropoietin (EPO) in patients with retinal vein occlusion (RVO) with control subjects. In addition, it investigates different RVO disease parameters (time of vein occlusion, patient age, vitreal vascular endothelial growth factor (VEGF) levels, and extent of central macular edema) for possible correlations with vitreal EPO levels.. Serum and vitreal EPO were measured from 6 patients with branch retinal vein occlusion, 6 patients with central retinal vein occlusion, and 12 control subjects (10 macular puckers and 2 macular holes).. Serum EPO levels (9.8 ± 4.9 mU/mL) did not differ between the RVO and control groups and were significantly lower than vitreal EPO levels in all groups. Vitreal EPO was elevated both in branch RVO (91 ± 59 mU/mL) and central RVO (182 ± 70 mU/mL) compared with controls (35 ± 24 mU/mL). Increased vitreal EPO correlated with higher vitreal VEGF (r = 0.64, P = 0.0008) and more pronounced central macular edema (r = 0.66, P = 0.001).. The results from this study indicate that EPO is locally expressed in the retina and that it is upregulated together with VEGF in RVO eyes. Because of its role both in neuroprotection and angiogenesis, ocular EPO might represent an interesting target to investigate in patients with RVO, especially in light of the current anti-VEGF treatments.

Topics: Aged; Aged, 80 and over; Enzyme-Linked Immunosorbent Assay; Erythropoietin; Female; Humans; Luminescent Measurements; Macular Edema; Male; Middle Aged; Retinal Perforations; Retinal Vein Occlusion; Up-Regulation; Vascular Endothelial Growth Factor A; Vitreous Body

Our purpose was to determine the vitreous erythropoietin (EPO) level in patients with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR).. The levels of EPO in vitreous were measured using a sandwich enzyme-linked immunosorbent assay kit from 64 patients, of whom 40 had RRD, 13 had PVR and 11 had idiopathic macular hole as control.. The mean levels of EPO in the RRD group (54.6 +/- 7.3 mU/ml) and PVR group (104.1 +/- 20.8 mU/ml) were significantly higher than that in the idiopathic macular hole control group (14.4 +/- 3.6 mU/ml; p < 0.001, p = 0.003, respectively). The mean EPO level in PVR was higher than that in RRD, but the difference was not significant (p = 0.112).. The vitreous EPO level was upregulated in eyes with RRD and PVR.

Topics: Aged; Enzyme-Linked Immunosorbent Assay; Erythropoietin; Humans; Middle Aged; Retinal Detachment; Retinal Perforations; Vitreoretinopathy, Proliferative; Vitreous Body