Massive Hemorrhage in PCV Is Associated With Lower-Than-Normal VEGF Level and Dramatically Elevated Inflammatory...

To compare the aqueous cytokine profile in polypoidal choroidal vasculopathy (PCV) with or without massive hemorrhage and typical neovascular age-related macular degeneration (nAMD).

The present comparative study included 81 treatment-naïve eyes from 75 patients (PCV with massive hemorrhage 20 eyes, PCV without massive hemorrhage 19 eyes, typical nAMD 19 eyes, and cataract control 23 eyes). 10 cytokines (VEGF, IL-6, IL-8, MCP-1, ICAM-1, VCAM-1, IP-10, G-CSF, and IFN-γ, IL-10) in the aqueous humor were measured by cytometric bead array.

VEGF levels in PCV with massive hemorrhage (median 5.20 pg/mL) were significantly lower than that in PCV without massive hemorrhage (median 34.76 pg/mL, p = 0.003) and typical nAMD (median 43.88 pg/mL, p < 0.001). They were even lower than that in normal cataract controls (median 22.02 pg/mL, p = 0.037). Multiple inflammatory cytokines were dramatically elevated in PCV with massive hemorrhage. IL-6, IL-8, MCP-1, ICAM-1, and IP-10 levels were significantly higher in PCV with massive hemorrhage than that in the other three groups. VCAM-1 levels were significantly higher in PCV with massive hemorrhage than that in typical nAMD and in control. G-CSF and IFN-γ levels were significantly higher in PCV without massive hemorrhage than that in control. IL-10 levels were significantly higher in PCV with massive hemorrhage than that in typical nAMD.

This pilot study showed that PCV with massive hemorrhage had a lower-than-normal VEGF level in aqueous humor and inflammation may be actively involved in the pathogenesis of massive hemorrhage in PCV.