Levels of vascular endothelial growth factor and filtration surgery outcomes in diabetic patients with acute primary...

This study aimed to compare aqueous humor vascular endothelial growth factor (VEGF) levels in diabetic patients who had experienced acute primary angle closure (APAC) and to evaluate the relationship between VEGF concentrations and outcomes following filtration surgery.

In this prospective study, aqueous humor specimens were obtained from 46 eyes of diabetic individuals with a history of APAC. VEGF levels were determined. Intraocular pressure (IOP) was assessed using Goldmann applanation tonometry. Anterior segment optical coherence tomography (AS-OCT) was employed to evaluate bleb morphology, and a bleb score was derived based on bleb dimensions and reflectivity. Follow-up examinations were performed at 1 week, and at 1, 3, 6, 12, and 18 months postoperatively.

All eyes underwent combined phacoemulsification, intraocular lens (IOL) implantation, and trabeculectomy, and were followed for 18 months. Based on surgical outcomes, eyes were categorized into a success group (34 eyes) and a failure group (12 eyes). Aqueous VEGF concentrations were markedly elevated in the failure group (P = 0.0018). Both univariate and multivariate analyses identified higher aqueous humor VEGF level was associated with surgical failure [univariate: P = 0.021, odds ratio (OR) = 9.826; multivariate: P = 0.030, OR = 8.542]. When eyes were stratified according to VEGF level, the low-VEGF group exhibited a significantly higher success rate compared with the high-VEGF group (overall success: P = 0.0276; complete success: P = 0.0073). Moreover, VEGF levels showed a significant positive correlation with bleb scores (Spearman's ρ =0.6840, 95% CI: 0.4845-0.8158, P < 0.0001).

In this small cohort of diabetic patients with a history of APAC, higher aqueous humor VEGF level was associated with less favorable filtration surgery outcomes. These findings are exploratory and suggest that VEGF may warrant further investigation as a potential marker. However, external validation in larger prospective cohorts is needed before clinical application.