Changes in Aqueous Vascular Endothelial Growth Factor and Pigment Epithelium-derived Factor after Ranibizumab Alone or Combined with Verteporfin for Exudative Age-related Macular Degeneration

Abstract

To investigate changes in aqueous vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after ranibizumab (Lucentis; Genentech Inc, South San Francisco, California, USA) monotherapy or combined with photodynamic therapy (PDT). Prospective, interventional, case-control study. We recruited 34 patients with CNV secondary to AMD and 10 controls. Baseline examinations, including visual acuity (VA), central macular thickness (CMT), fluorescein angiography, and indocyanine angiography, were performed, and the measurements of VA and CMT were repeated 1 month after treatments. Seventeen of 34 patients received a single intravitreal injection of 0.5 mg ranibizumab, and the remaining 17 patients underwent combined PDT on the same day. Aqueous samples were collected at the time of injection and 1 month after treatment and were measured by enzyme-linked immunosorbent assay. Main outcomes measures were the changes in VA and CMT and the changes in VEGF and PEDF levels. Demographic features, lesion characteristics, and mean changes in VA and CMT were similar between the two groups. Aqueous VEGF and PEDF levels were reduced significantly 1 month after treatment in all patients. The reduction levels of VEGF and PEDF were similar between the two groups. There was a positive correlation between the reduction levels of aqueous VEGF and the reduction levels of aqueous PEDF. The reduction levels of VEGF and PEDF were correlated positively with the decrease in CMT, but were not positively correlated with the improvements in VA. Ranibizumab therapy for CNV secondary to AMD is associated with reduced levels of aqueous VEGF and PEDF regardless of combined therapy with PDT. The reduction levels of VEGF and PEDF are correlated with anatomic improvements in the macula.