Investigating Renin-Angiotensin-Aldosterone System Activation in Proliferative Vitreoretinopathy: Elevated Vitreous...

The objective of this study is to elucidate the involvement of the local renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of rhegmatogenous retinal detachment (RRD) accompanied by proliferative vitreoretinopathy (PVR), with a specific focus on vitreous concentrations of renin, angiotensinogen, and angiotensin-converting enzyme (ACE).

In this prospective observational study, 75 patients were divided into three groups: advanced-stage PVR with RRD (n = 25), early stage PVR with RRD (n = 25), and epiretinal membrane (ERM) controls (n = 25). At the commencement of pars plana vitrectomy, undiluted vitreous samples were aspirated and analyzed for renin, angiotensinogen, and ACE concentrations using ELISA. Statistical comparisons were conducted using Kruskal-Wallis, Mann-Whitney U, and multinomial logistic regression analyses.

ACE levels were markedly elevated in the advanced-stage PVR group compared to both early-stage PVR (p = 0.006) and control groups (p = 0.011). No significant differences were observed in renin or angiotensinogen levels among the three groups. Pseudophakic patients exhibited significantly higher angiotensinogen levels than phakic patients (p = 0.009). Each unit rise in ACE level was linked to a 73-fold greater risk of developing advanced-stage PVR, as demonstrated by multinomial logistic regression (p = 0.003).

The significant elevation of ACE in advanced PVR cases suggests a potential role for local RAAS activation in disease progression. These findings support further investigations of RAAS modulation as a candidate for therapeutic intervention in PVR.