Samsudin, Norhayaty
(2017)
A comparison study on aqueous humor transforming growth factor-beta (TGF-β) and vascular endothelial growth factor (VEGF) level in primary glaucoma patients and controls.
Masters thesis, Universiti Sains Malaysia.
Abstract
INTRODUCTION
Glaucoma can be classified into two main groups according to the angle structure; closed
angle glaucoma and open angle glaucoma. Open and closed angle glaucoma can further be
classified into primary or secondary glaucoma. Primary open angle glaucoma (POAG) is the
most common type of glaucoma. Primary angle closure glaucoma (PACG) has been noted to
have a relatively high prevalence in Southeast Asia, and to be a leading cause of blindness in
this region.
Transforming growth factor (TGF- β) regulates the proliferation and differentiation of cells,
embryonic development, wound healing, and angiogenesis. Vascular growth endothelial
factor (VEGF) is a signaling peptide produced by cells to stimulate both vasculogenesis and
angiogenesis. In the process of wound healing, there is a complex interplay of mediators
comprised of growth factors, cytokines and chemokines. Understanding the role of growth
factors such as TGF-β and VEGF in the ocular wound healing cascade may increase the
success rate of glaucoma filtering surgery and knowledge on pathogenesis of primary
glaucoma.OBJECTIVE
To compare the transforming growth factor- beta (TGF-β) and vascular growth endothelial
factor (VEGF) level in aqueous humor of primary glaucoma patients and controls.METHODOLOGY
This prospective cross-sectional study was conducted between November 2013 and February
2017 at Hospital Universiti Sains Malaysia. In total, 63 eyes of 63 patients undergoing
cataract surgery or primary augmented trabeculectomy surgery were included in this study.
Recruited subjects were classified into primary glaucoma (POAG and PACG) group and
control group. Aqueous humor samples were prospectively collected at the beginning of
surgery from 32 eyes with primary glaucoma (16 POAG and 16 PACG) and from 31 control
eyes that underwent cataract operation and primary augmented trabeculectomy. The
concentration of TGF-β and VEGF levels was measured by using enzyme-linked
immunosorbent assay test (ELISA).
RESULTS
The median concentration (interquertile range (IQR) of TGF-β in the aqueous humor of eyes
with POAG was 2432.50 ± 3233.57 pg/ml, 1787.40 ± 1650.37 pg/ml in PACG and 1571.40 ±
409.20 pg/ml in controls. Median levels of TGF-β were observed to be significantly higher in
the POAG group and PACG group compared to controls (p = 0.004 and p = 0.015). However
there was no significant difference between POAG and PACG patients (p = 0.300).
There was also no significant differences in median levels of VEGF between patients with
primary glaucoma compared to controls (p =0.085), or between POAG and PACG patients
(p= 0.043). The median concentration of VEGF in the aqueous humor of eyes with POAGwas 518.58 ± 542.61 pg/ml, 307.69 ± 194.39 pg/ml in PACG and 330.20 ± 202.40 pg/ml in
controls.
CONCLUSION
The aqueous humor TGF-β level was significantly higher in eyes with primary glaucoma
compared to control. TGF-β in the aqueous humor may play a role in the pathogenesis of
POAG and PACG. The aqueous humor VEGF level did not differ significantly between eyes
with primary glaucoma compared to controls, and between eyes with POAG and PACG.
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