Prostaglandin use is associated with increased vascular endothelial growth factor in the aqueous humor of glaucoma patients

VEGF levels in the aqueous humor of patients with primary open angle glaucoma: A systematic review and a meta-analysis

PURPOSE

To compare the VEGF levels in the aqueous humor of patients with Primary Open Angle Glaucoma (POAG) and non-glaucomatous eyes and reveal any potential statistically significant correlations.

METHODS

We searched PubMed, from inception to December 31, 2021. Key search terms included VEGF and Glaucoma. All relevant studies that evaluated the VEGF levels in patients with POAG and in the control group were included in this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines were followed. Data were extracted independently by 2 authors. Heterogeneity was statistically quantified by Q, H, and I2 statistics, and a meta-analysis was performed using the random-effects model.

RESULTS

Seven cross-sectional studies were included in the meta-analysis. 144 eyes were enrolled in the POAG group and 162 eyes in the control group. The random effect model showed no statistically significant difference between the two groups (SMD =0.284, 95% CI = -0.173 to 0.741; P = 0.223), but we noticed a trend towards elevated VEGF levels in the aqueous humor of POAG patients. Significant heterogeneity was detected (I2 = 74.1%, P = 0.001).

CONCLUSIONS

This systematic review and meta-analysis indicates a trend towards elevated VEGF-A levels in the aqueous humor of patients with POAG and suggests a potential neuroprotective role of VEGF in patients with POAG. Future studies are required to evaluate the exact role of VEGF in POAG.

Initial Glaucoma Medication in the Hypertensive Phase Following Ahmed Valve Implantation: A Comparison of Results Achieved Using Aqueous Suppressants and Prostaglandin Analogs

Background: To compare the effects of aqueous suppressants (AS) and prostaglandin (PG) analogs during the hypertensive phase on intraocular pressure (IOP) and surgical outcomes. Methods: In this retrospective, observational study, 66 eyes (66 patients) with Ahmed glaucoma valve (AGV) implantation were included. As evaluation items, IOP changes, number of postoperative medications, the surgical success rate, and postoperative complications were examined. Complete success was defined as IOP between 6 and 21 mmHg without medications, while qualified success was with a maximum of four medications. Results: The short-term IOP reduction following initial medication was 9.3 mmHg for AS and 4.4 mmHg for PG analogs (p = 0.016). More postoperative medications were used in PG than in AS from postoperative 3 months to 3 years (all p < 0.05). The qualified success rate with the initial medication was higher in AS than in PG (67.5% vs. 42.3% at 1 year, 80.6% vs. 37.5% at 2 years, 80.0% vs. 35.0% at 3 years, all p < 0.05). Conclusions: Association between AS used as the first medications during the hypertensive phase and better IOP control and a higher success rate was observed. The type of the initial glaucoma medication after AGV implantation could affect short- and long-term surgical outcomes.