Evaluation of Serum and Aqueous Humor Vascular Endothelial Growth Factor in Neovascular Glaucoma

Purpose: The study aimed to evaluate and correlate between the levels of vascular endothelial growth factor (VEGF) in serum and aqueous humor in cases of neovascular glaucoma (NVG) to stand up on if it can be used as a marker for early detection of such cases. Methods: This observational case control study included 60 eyes, divided into 3 groups, group A of 30 eyes presented by cataract of different causes (not diabetic patients and no signs of NVG) as a control group and group B of 30 eyes with NVG due to different causes, group C of the same eyes in group B but after one month of treatment by intravitreal bevacizumab and laser treatment by pan retinal photocoagulation (PRP). Serum VEGF was estimated in all groups, also aqueous humor VEGF was estimated in group A and B only. In addition glycosylated hemoglobin (HbA1c) was estimated in group B;statistical analysis of the results was performed. Results: The study revealed that the commonest cause of NVG was proliferative diabetic retinopathy (PDR) in 26 cases (86.7%), HbA1c in group B revealed mean value 7.68% ± 2.75%. Serum VEFG level in the group B of cases of NVG was significantly higher than the control group A (P 0.05). Conclusions: VEGF is considered a good marker for the NVG either in serum or aqueous humor, laser treatment and the use of anti-VEGF are crucial treatment for such cases, and also glycemic control is a must for regulation of the vascular process in diabetic patients for prevention of such ocular neovascularization.

The Role of Serum Ceruloplasmin and Oxidative Stress Markers in Primary Open Angle Glaucoma

Purpose: The study aimed at evaluation of the role of ceruloplasmin (A protein involved in iron homeostasis and can inactivate free radicals) and other oxidative stress markers as superoxide dismutase (SOD), malondialdehyde (MDA) and catalase activity (CAT) in primary open angle glaucoma (POAG). Methods: This observational case control study included 90 persons divided into 3 equal groups: group A of 30 normal persons as a control group, group B of 30 patients of untreated (POAG) (firstly diagnosed) by the clinical characters including measuring intraocular pressure (IOP), optic disc cupping and visual field changes and group C of 30 patients of POAG under medical treatment by topical anti-glaucomatous drugs. Serum ceruloplasmin, superoxide dismutase, malondialdehyde and catalase activity were measured in all groups, statistical analysis of the data was performed. Results: In a comparison to group A of control, serum ceruloplasmin decreased significantly in group B of untreated POAG (20.95 ± 6.01) mg-dl and in group C of POAG under treatment (22.15 ± 6.14) mg-dl (P 0.05). Also, serum superoxide dismutase increased significantly in group B (2.23 ± 0.4) and in group C (2.19 ± 0.38) U-ml (P 0.05). Serum malondialdehyde increased significantly in group B (3.82 ± 0.74) nmol-ml and in group C (3.55 ± 0.73) nmol-ml (P 0.05). Serum catalase decreased significantly in group B (17.97 ± 2.75) U-ml and in group C (18.75 ± 2.33) U-ml in a comparison to the control group A (22.67 ± 3.05) U-ml (P 0.05). Conclusions: Serum ceruloplasmin level and the antioxidant (CAT) activity significantly decreased, while serum levels of SOD, MDA significantly increased in cases of POAG. This may indicate the need for addition of anti-oxidative stress therapy in combination with the anti-glaucomatous drugs. Monitoring these markers can be considered good indicators for determination of the oxidative stress condition in such cases.

Serum C-Reactive Protein and Diabetic Retinopathy

Purpose: To study the role of C-reactive protein (CRP) in the progression of diabetic retinopathy before and after treatment to determine if it can be used as a biomarker for progression or regression. Methods: This observational case study included 90 persons divided into 4 groups: group A of 30 normal persons (non diabetic) as a control group, group B of 30 diabetic patients without retinopathy, group C of 30 untreated patients with proliferative diabetic retinopathy (PDR) and group D of the same patients of group C after 3 months of laser treatment by pan retinal photocoagulation (PRP). Serum CRP protein was measured in all groups, interpretation of results was applied. Results: The study revealed that serum CRP level increased significantly in patients with PDR (group C) in comparison to both groups of normal control persons (group A) and diabetic patients without retinopathy (group B) (P 0.05). Also the same finding was noticed in elderly patients above 50 years. Conclusion: CRP is considered a biomarker for PDR even in older age patients, but not a good indictor used for follow up patients after treatment.

Effects of Laparoscopic Cholecystectomy on Intraocular Pressure

Purpose: To evaluate the effects of laparoscopic cholecystectomy in patients with gall stones under general anesthesia using carbon dioxide (CO2) insufflations on the intraocular pressure (IOP). Methods: The study was an observational case series, involved 24 non-glaucomatous patients with gall stones who underwent laparoscopic cholecystectomy surgery under general anesthesia using (CO2) insufflations in the period from January 2016 to April 2016 in Zagazig University Hospitals. IOP was measured preoperatively, intra-operatively and shortly postoperatively. Interpretation of the results was performed. Results: The study revealed that IOP was elevated significantly during laparoscopic cholecystectomy surgery (P < 0.001), as the mean preoperative IOP was (15.21 ± 1.61 mmHg) compared to intra-operative (24.55 ± 6.28 mmHg) and nearly returned to the normal level after 8 hours postoperatively (16.13 ± 2.44 mmHg). Conclusion: Laparoscopic cholecystectomy surgery elevated IOP significantly which is not favorable for glaucoma or ocular hypertension patients, especially for the old.