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Editors Selection IGR 15-2

Surgical Therapy: Tenon tissue VEGF levels and surgical outcomes

Comment by Malik Kahook on:

49038 Level of Vascular Endothelial Growth Factor in Tenon Tissue and Results of Glaucoma Surgery, Park HY; Kim JH; Ahn MD et al., Archives of Ophthalmology, 2012; 130: 685-689

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Vascular Endothelial Growth Fac tor (VEGF), an active par tici pant in the wound-healing cascade, induces collagen deposition and scar formation. It follows that several investigators have studied the relationship between VEGF levels and clinical outcomes after glaucoma surgery. Park et al. follow in the footsteps of previous publications by exploring the relationship between VEGF levels and surgical success after trabeculectomy or Ahmed valve implantation. The control group included patients undergoing cataract extraction. They found significant differences in Tenon's fibroblast VEGF levels between patients who were considered surgical failures compared to surgical success and control patients. There was no significant difference in aqueous humor VEGF levels between groups. Tenon's fibroblast VEGF, but not aqueous humor VEGF, levels correlated with final intraocular pressure (IOP) after surgical intervention. One third of patients were considered surgical failures after one year. Surgical success appears to be primarily based on an IOP level < 21 mmHg with or without use of topical IOP lowering therapy. The authors do not provide further details for patients who were considered surgical failures making an in depth analysis difficult at best. Limitations to the study include a small number of patients that preclude making statements that link surgical success with VEGF levels as well as the mixing of results from trabeculectomy and drainage device implantation. Exploring the link between VEGF levels and surgical outcomes in patients with glaucoma requires a well-defined patient population undergoing a standard surgical procedure and followed systematically with comparison to a control group.

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