Einfluss des retinalen Koagulationsstatus auf oxidative Metabolite und VEGF bei 208 Patienten mit proliferativer diabetischer Retinopathie

Albert J. Augustin; A. Keller; F. Koch; B. Jurklies; B. Dick

doi:10.1055/s-2001-12251

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2001; 218(2): 89-94
DOI: 10.1055/s-2001-12251

KLINISCHE STUDIE

Georg Thieme Verlag Stuttgart · New York

Einfluss des retinalen Koagulationsstatus auf oxidative Metabolite und VEGF bei 208 Patienten mit proliferativer diabetischer Retinopathie[1] [2]

Influence of retinal coagulation status on retinal oxidative metabolites and VEGF level in 208 patients suffering from proliferative diabetic retinopathyAlbert J. Augustin¹ , A. Keller¹ , F. Koch² , B. Jurklies³ , B. Dick¹

¹ Universitäts-Augenklinik, Langenbeckstraße 1, 55131 Mainz (Direktor: N. Pfeiffer), E-Mail: 106020.560@compuserve.com
² Universitäts-Augenklinik Frankfurt
³ Universitäts-Augenklinik Essen

Abstract

Zusammenfassung

Hintergrund Oxidative Metabolite und Zytokine sollen an der Pathogenese der (proliferativen) diabetischen Retinopathie beteiligt sein. Ziel dieser Studie war es, bei Diabetikern gewonnene Glaskörperproben und fibrovaskuläre Proliferationen auf ihren Gehalt an oxidativen Metaboliten und VEGF zu untersuchen und diese Werte mit dem Koagulationsstatus der Netzhaut zu korrelieren.

Patienten und Methoden Die Studie wurde an 208 vitrektomierten Patienten mit Diabetes mellitus (Typ I: 114, Typ II: 94) durchgeführt. Die Patienten wurden in drei Gruppen eingeteilt: (1) Keine bzw. minimale präoperative Koagulation [mittlere Behandlungsfläche, BF: 156 mm²], (2) Koagulation (Laserflächenkoagulation und/oder Kryokoagulation) kürzer als 3 Monate vor der Operation [BF: 589 mm²]. (3) Koagulation länger als 3 Monate vor der Operation [BF: 546 mm²]. Im Glaskörper und, falls vorhanden, in den fibrovaskulären Proliferationen (Typ I: 83; Typ II: 73) wurden der Gehalt an Lipidperoxiden (LPO) mit zwei Methoden und der Gehalt an VEGF gemessen.

Ergebnisse Im Glaskörper waren die Lipidperoxidwerte in Gruppe 1 signifikant (P < 0,01 für Diabetes Typ I und II und beide Messmethoden) höher als in den anderen beiden Gruppen. Eine ebenfalls signifikante Erniedrigung fand sich in Gruppe 3 im Vergleich zu Gruppe 2 (P < 0,01 für Diabetes Typ I und P < 0,05 für Diabetes Typ II). Auch bei den Proliferationen ergaben die Koagulation und der Zeitfaktor signifikante Unterschiede. Nur bei Typ-I-Diabetikern waren die VEGF-Werte im Glaskörper infolge der Koagulation und nach der Wartezeit jeweils signifikant (P < 0,01) reduziert. Bei Diabetes Typ II führte erst die Wartezeit von mehr als 3 Monaten zu einer signifikanten (P < 0,01) Reduktion der Werte. Bei den Proliferationsproben hatten sowohl die alleinige Koagulation als auch die zusätzliche Wartezeit jeweils eine signifikante (P < 0,05 für Diabetes Typ I und II) Reduktion der Werte zur Folge.

Schlussfolgerung Der zeitliche Zusammenhang der LPO- und VEGF-Ergebnisse lässt darauf schließen, dass die bei der diabetischen Retinopathie produzierten oxidativen Metabolite auch an der Unterhaltung der Wachstumsaktivität der Proliferationen über die Induktion von VEGF beteiligt sein können. Ein In-vitro-Beweis bzw. eine prospektive Untersuchung zur Untermauerung dieser These stehen noch aus.

Background Oxidative metabolites and different cytokines are believed to be involved in the pathogenesis of (proliferative) diabetic retinopathy. It was the aim of this study to analyze vitreous body and proliferations of diabetic patients for oxidative metabolites and VEGF und to correlate these values to the retinal coagulation status.

Patients and Methods The study was performed in 208 patients vitrectomized for diabetic retinopathy (Type I: n = 114, Type II: n = 94). Grouping of patients was performed according to retinal coagulations status: (1) no or minimal preoperative coagulation [mean coagulation area, CA: 156 mm²], (2) coagulation (scatter laser coagulation und/oder cryopexy) < 3 months before surgery [CA: 589 mm²]. (3) coagulation > 3 months before surgery [CA: 546 mm²]. In the vitreous body and, if present, in the fibrovascular proliferations (Type I: n = 83; Type II: n = 73) the level of lipid peroxides (LPO, measured with two methods) and VEGF was determined.

Results In the vitreous body LPO in group 1 were significantly (P < 0,01 (Type I und II)) higher as compared to other groups. In group 3 LPO were significantly lower as compared to group 2 (P < 0.01 (Typ I) and P < 0.05 (Typ II)). Similiar results were observed in the proliferations. In Type I patients VEGF values were significantly (P < 0.01 for group 1 vs. 2 and groups 1/2 vs. 3) reduced following coagulation and coagulation + 3 months. In Type II patients only group 3 was significantly (P < 0.01) different from group 1. In proliferations groups 2 and 3 were signifcantly different from group 1 (P < 0.05 for Typ I and Type II patients).

Conclusions The time course of the values leads to the conclusion that oxidative metabolites are able to directly modulate growth activity and to exert this effect via induction of VEGF. This hypothesis has to be confirmed in vitro and by means of a prospective study.

Schlüsselwörter

Diabetes mellitus - Retinopathie - oxidative Metabolite - VEGF

Key words

Diabetes mellitus - retinopathy - oxidative metabolites - VEGF

Full Text

References

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