July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Degree of Capillary Nonperfusion Noted on Wide-angle Angiography Directly Correlate With Intravitreal VEGF Levels in Proliferative Vascular Retinopathies
Author Affiliations & Notes
  • K V Chalam
    Loma Linda University School of Medicine, Loma Linda, California, United States
  • Shilesh Gupta
    ophthalmology, Florida Atlantic University, Fort Lauderdale, Florida, United States
  • Footnotes
    Commercial Relationships   K V Chalam, None; Shilesh Gupta, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6540. doi:
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      K V Chalam, Shilesh Gupta; Degree of Capillary Nonperfusion Noted on Wide-angle Angiography Directly Correlate With Intravitreal VEGF Levels in Proliferative Vascular Retinopathies. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6540.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To evaluate the relationship between degree of capillary nonperfusion (CNP) assessed with ultra-wide field fluorescein angiography in patients with proliferative retinal vasculopathies and intraocular vascular endothelial growth factor (VEGF)

Methods : Vitreous samples (N=78) were obtained from patients who underwent vitrectomy for proliferative vascular retinopathies (PDR, CRVO, SCR ) with CNP and neovascularization.Ultra-wide field FA images obtained with the Optos C200 MA after standard intravenous infusion of 5 cc of sodium fluorescien 10% were reviewed using the V2 Vantage custom Software and CNP was measured.The area of CNP was defined as the area where a dropout of the retinal capillary bed was detected in the FA image. Images during the arteriovenous phase was graded for CNP in a masked fashion. The area of CNP seen in the arteriovenous phase image was encircled using the area measurement function and divided by the total image area in pixels (ischemic index).
Vitreous samples were analyzed by immunobead assay (Luminex Crop, Austin, TX, USA). Immunossay kits were used for the detection of VEGF. Samples were read using the suspension array system. VEGF was measured in picograms per ml. Sensitivity ranged from 0.86 to 3000 pcg.

Results : A total of 78 ultra-wide field fluorescein angiograms from 62 patients were reviewed. The mean ischemic index was 59% (range 13-94%). The average ischemic index of eyes within subgroups 1, 2, 3 was 52%, 66%, and 68% respectively. The mean ischemic index of eyes with PDR was 67% (SD 26%; range 24-84%). CRVO was 47% (SD 21%; range 5-67%) and sickle cell retinopathy was 64% (SD 21%; range 14-77 %)
The mean vitreous VEGF concentrations in the eyes were 499.3 pg/mL ± 322.9 pg/mL (range 16.5 pg/mL−2675.3 pg/mL). The vitreous VEGF concentration was 630.2 pg/mL ± 330.7 pg/mL (130.2 pg/mL−2986 pg/mL) in the PDR group, 271.4 pg/mL ± 42.5 pg/mL (92.4 pg/mL−1626.6 pg/mL) in the CRVO group. The degree of ischemic index strongly correlated with the vitreous VEGF concentration (r = 0.754, P = 0.0002).

Conclusions : The vitreous VEGF concentration in proliferative retinal vasculopathies increased significantly and correlated with the size of the NPA and ischemic index. Anti VEGF therapy combined with aggressive retinal photocoagulation of all nonperfused areas optimizes management of proliferative retinal vasculopathies.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.


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