Aqueous Vascular Endothelial Growth Factor as a Predictor of Macular Thickening Following Cataract Surgery in Patients With Diabetes Mellitus

PURPOSE: To study associations between serum and aqueous vascular endothelial growth factor (VEGF) and insulin,like growth factor 1 (IGF-1) and macular edema measured with optical coherence tomography (OCT) following phacoemulsification in diabetic patients. DESIGN: Cohort study. METHODS: A pilot study of 36 consecutive diabetic patients undergoing planned phacoemulsification with IOL in I eye by one surgeon at the University of North Carolina consented to preoperative and postoperative OCT central subfield (CSF) thickness measurements and aqueous and blood samples for VEGF and IGF-1. Four patients with clinically significant macular edema (CSME) received laser preoperatively. Spearman-rank correlations were performed between growth factors and mean CSF or a clinically meaningful percent change in CSF (>11% of preoperative measurement) at 1 and 6 months postoperatively. RESULTS: There were no surgical complications or new cases of CSME following surgery. Mean aqueous VEGF in patients with retinopathy, determined preoperatively, increased with increasing level of severity. Patients with preoperative CSME also had severe or worse retinopathy and the greatest mean aqueous VEGF. Significant preoperative correlations existed between aqueous VEGF and more severe retinopathy whether CSME was present or absent (r = 0.49; P = .007), and between aqueous VEGF and CSME (r = 0.41; P = .029). At 1 month postoperative, aqueous VEGF was positively correlated with >11% change from preoperative CSF regardless of CSME status (r = 0.47; P = .027). No noteworthy associations existed between CSF and IGF-1 values. CONCLUSIONS: Aqueous VEGF was significantly positively associated with a clinically meaningful change in CSF in diabetic patients 1 month following cataract surgery. Accounting for preoperative CSF was important. Fur, ther study is indicated. (Am J Ophthalmol 2009; 148: 895-901. (C) 2009 by Elsevier Inc. All rights reserved.)