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Takehito Iwase, Hirotaka Yokouchi, Takayuki Baba, Toshiyuki Oshitari, Shuichi Yamamoto; Serum Level of Vascular Endothelial Growth Factor and Opening Lumbar Pressure Significantly Correlated with Optic Disc Edema in Patients with POEMS Syndrome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3880.
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It has been shown that the intracranial pressure (ICP) can induce optic disc edema (ODE), and high serum levels of vascular endothelial growth factor (VEGF) can also induce ODE in patients with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. We performed a cross sectional observational study to determine whether there is a significant correlation between the peripapillary retinal nerve fiber layer (RNFL) thickness and the serum level of VEGF and the spinal lumbar pressure (LP).
We studied 32 eyes of 16 treatment-naïve patients (11 men, 5 women) with the POEMS syndrome at the Chiba University Hospital from September 2012 through October 2014. The diagnosis of POEMS was made by the criteria established by Dispenzieri in 2007. The peripapillary RNFL (pRNFL) thickness was determined by optical coherence tomography (OCT: RTVue-100 Optovue, Inc.). The serum level of VEGF was measured by enzyme-linked immune sorbent assay (ELISA). The opening (LP) pressure was measured instead of the ICP. The correlation between the pRNFL thickness and the serum level of VEGF and opening LP pressure was determined by the Spearman’s rank-correlation coefficient.
The mean serum level of VEGF was 5130 ± 3590 pg/ml with a range of 1330 to 11900 pg/ml. The mean opening LP pressure was 179.1 ± 56.4 mmH2O. There was a significant positive correlation between the pRNFL thickness and the opening LP pressure (r=0.67, P=0.0002), and also between the pRNFL thickness and the serum level of VEGF (r=0.37, P=0.03). In addition, there was a strong positive correlation between the pRNFL thickness of the right and left eyes (r = 0.81, P=0.0001). On the other hand, the correlation between the serum level of VEGF and opening LP pressure was not significant (r=0.32,P=0.32).
The significant positive correlation between the pRNFL thickness and the opening LP and also with the serum levels of VEGF are in accord with previous studies reporting that the ICP and the serum levels of VEGF can affect the ODE in POEMS patients. These results suggest that both the higher LP and the serum levels of VEGF can account for the development of ODE in patients with POEMS syndrome.
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