In Austria, investigators sought to determine the level of vascular endothelial growth factor (VEGF) in the plasma of patients with diabetic macular edema (DME) and of patients with exudative age-related macular degeneration (AMD) before and after intravitreal injection of bevacizumab, ranibizumab or pegaptanib.

They included 30 patients with DME and 30 patients with AMD in this randomized, controlled study and randomized them to treatment with ranibizumab (0.5 mg), bevacizumab (1.25 mg) or pegaptanib (0.3 mg). A total of 10 patients with DME received bevacizumab, 10 ranibizumab and 10 pegaptanib. The same randomized treatment allocation applied to the 30 patients with AMD. The investigators measured the concentrations of VEGF by ELISA just before the injection, seven days after and one month after.

They reported that plasma VEGF in patients with exudative AMD before the injection of bevacizumab was 89.7 pg/ml and that it was significantly reduced to 25.1 pg/ml after seven days (p=0.01), and to 22.8 pg/ml after one month (p=0.008). In patients with DME, they observed the same systemic reduction by bevacizumab with a significant decrease of baseline VEGF level from 72.2 pg/ml to 13.7 pg/ml after seven days (p=0.008) and 17.1 pg/ml at four weeks with (p=0.012). They found no significant reductions of plasma VEGF in patients receiving ranibizumab or pegaptanib during follow-up.

In conclusion, bevacizumab significantly reduces the level of VEGF in the blood plasma for up to one month in patients with DME as well as in those with ARMD. No significant systemic effects of intravitreal ranibizumab or pegaptanib on plasma VEGF could be observed.

The authors of this comparative case series evaluated the efficacy of loteprednol etabonate 0.5% versus prednisolone acetate 1.0% for the control of postoperative inflammation in patients having routine cataract surgery.

According to the authors, patients were at least 18 years of age and scheduled for routine cataract surgery. They were excluded from the study if they had pre-existing medical conditions (i.e., elevated IOP, retinopathy, maculopathy, uveitis) or required mediations the investigator believed would put the patient at risk or confound the study. They then randomized patients to receive loteprednol etabonate or prednisolone acetate four times daily in addition to bromfenac 0.09% and besifloxacin 0.6% after surgery. The study authors assessed visual acuity, IOP and anterior chamber cell and flare intensity over three weeks following cataract surgery. The primary endpoint was the level of anterior chamber cell and flare intensity in patients treated with loteprednol etabonate or prednisolone acetate.

The study enrolled 88 patients (46 loteprednol etabonate and 42 prednisolone acetate); equivalency was achieved between the two treatment groups with no significant differences throughout the three-week follow-up. The authors noted that there was less fluctuation in IOP assessments in patients treated with loteprednol etabonate than in patients treated with prednisolone acetate, in particular one day and three days postoperatively.

The results indicate that equivalent control of inflammation can be obtained through treatment with loteprednol etabonate or prednisolone acetate after cataract surgery. In addition, treatment with loteprednol etabonate may result in less IOP fluctuation.

Endothelin-1 (ET-1) has been suggested to play an important role in the pathogenesis of glaucoma. Researchers studied whether increased levels of plasma ET-1 are associated with changes in the visual field and changes in optical coherence tomography (OCT)-measured retinal nerve fiber layer (RNFL) thickness in patients with different types of glaucoma.

They determined plasma concentrations of ET-1 in 31 patients with primary open-angle glaucoma (POAG), 18 patients with normal-tension glaucoma (NTG), 16 patients with primary angle-closure glaucoma (PACG) and in 37 normal controls. In all participants, the researchers performed visual field testing and used OCT to measure RNFL thickness. They then evaluated the correlation between mean ET-1 level and changes in the visual field (mean deviation, dB) and changes in OCT-measured RNFL thickness in one randomly selected eye from each patient in each group.

The ET-1 level was 3.27 ± 1.25 pg/mL in the primary open-angle glaucoma group (–14.09 ± 8.76 dB), 3.12 ± 1.46 pg/mL in the NTG group (–8.87 ± 6.15 dB), 2.58 ± .22 pg/mL in the POAG group (–14.55 ± 10.2 dB) and 1.53 ± 1.49 pg/mL in the control group. Although mean ET-1 levels were significantly higher in all three of the glaucoma groups than in the control group, the researchers found no significant difference in ET-1 level among the three glaucoma groups. Furthermore, no significant correlation was found between levels of plasma ET-1 and structural or functional changes in patients with different types of glaucoma.

To conclude, there was no correlation between plasma levels of ET-1 and severity of glaucoma. The role of ET-1 plays in the pathogenesis of glaucoma remains to be determined.