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"Latar belakang: Ulkus kornea dapat menyebabkan kebutaan karena sikatriks kornea. Transplantasi kornea sebagai tatalaksana sikatriks kornea berisiko tinggi mengalami kegagalan dengan adanya neovaskular pada kornea resipien. VEGF-A diduga sebagai faktor angiogenik utama dalam terbentuknya neovaskular kornea. Berdasarkan pengamatan klinis, neovaskular kornea pada pasien ulkus kornea bakteri lebih luas dibandingkan ulkus kornea jamur, namun belum pernah dibandingkan secara ilmiah. Tujuan: Studi ini membandingkan VEGF-A air mata dan neovaskularisasi kornea antara ulkus kornea bakteri dan jamur. Korelasi antara VEGF-A dengan luas neovaskular juga dihitung. Metode: Penelitian dilakukan terhadap pasien ulkus kornea bakteri dan jamur dengan sampel foto kornea dan air mata. Pengambilan sampel dilakukan pada hari pertama kedatangan dan diulang pada minggu keempat. Analisis foto kornea menggunakan peranti lunak ImageJ® untuk menilai luas neovaskular kornea dan luas defek kornea. Analisis VEGF-A air mata menggunakan enzyme-linked immunosorbent assay (ELISA). Perbedaan dianggap signifikan jika p<0,05. Hasil: Didapatkan 12 subjek ulkus kornea bakteri dan 10 subjek ulkus kornea jamur dengan rerata usia 37 tahun. Bakteri terbanyak Pseudomonas aeruginosa. dan jamur terbanyak Fusarium sp. Defek kornea setara pada awal (bakteri 25,6% (1,8-81,5) vs jamur 22,7% (3,0-45,0), p = 0,644) dan membaik pada minggu keempat (bakteri 0,04% (0-30,5) vs jamur 2,5% (0-15,1), p=0,368). Luas neovaskular kornea pada hari pertama setara (bakteri 10,3% (2,3-37,5) vs jamur 8,0% (3,7-22,8), p = 0,262) namun pada minggu keempat lebih luas pada kelompok bakteri (bakteri 21,6% (2,3-58,0) vs jamur 11,0% (5,4-22,5), p=0,033). VEGF-A air mata setara pada hari pertama (bakteri 215,6 pg/ml (58,0-1111,6) vs jamur 339,3 pg/ml (22,7-1313,0), p=0,391) dan minggu keempat (bakteri 399,7 pg/ml (181,9-1496,3) vs jamur 743,8 pg/ml (78,7-1416,5), p=0,792). Tidak didapatkan korelasi VEGF-A terhadap luas area neovaskular kornea (hari pertama r -0,28, p=0,212, minggu keempat r -0,04 p=0,855). Kesimpulan: Perbedaan luas neovaskular pada minggu keempat diduga karena faktor proangiogenik pada bakteri yang jarasnya melalui VEGF-A serta faktor antiangiogenik pada jamur yang mengalahkan pengaruh VEGF-A. Diperlukan penelitian mendasar yang mencari faktor antiangiogenik tersebut pada jamur.

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Background: Corneal ulcer can cause blindness due to corneal cicatrix. Corneal transplantation as the treatment of corneal cicatrix had higher risk for rejection or failure if the recipient’s cornea possessed neovascularization. VEGF-A was thought to be the major angiogenic factor in corneal neovascularization. Based on clinical observation, corneal neovascularization in bacterial corneal ulcers had more area than in fungal corneal ulcers, however it was never proved scientifically. Objective: This study aimed to compare tear fluid VEGF-A and corneal neovascularization between bacterial and fungal corneal ulcers. The correlation between VEGF-A and neovascular area was also measured. Methods: Corneal photograph and tear fluid samples of bacterial and fungal in corneal ulcer patients were studied. Sample was taken at the first visit and at the fourth week follow up. Corneal photograph was analyzed using ImageJ® software to measure neovascular area and defect area. Tear fluid VEGF-A was examined using enzyme-linked immunosorbent assay (ELISA). Difference was considered significant if p<0,05. Results: There were 12 bacterial corneal ulcer patients and 10 fungal corneal ulcer patients with mean age 37 years old. Most common bacteria was Pseudomonas aeruginosa and most common fungi was Fusarium sp. Corneal defect area between the groups was similar at the first visit (bacterial 25,6% (1,8-81,5) vs fungal 22,7% (3,0-45,0), p = 0,644) and improved at the fourth week (bacterial 0,04% (0-30,5) vs fungal 2,5% (0-15,1), p=0,368). Neovascular area was similar among the groups at the first visit (bacterial 10,3% (2,3-37,5) vs fungal 8,0% (3,7-22,8), p = 0,262), however bacterial group showed larger area at the fourth week (bacterial 21,6% (2,3-58,0) vs fungal 11,0% (5,4-22,5), p=0,033). Tear fluid VEGF-A was similar at the first visit (bacterial 215,6 pg/ml (58,0-1111,6) vs fungal 339,3 pg/ml (22,7-1313,0), p=0,391) and the fourth week (bacterial 399,7 pg/ml (181,9-1496,3) vs fungal 743,8 pg/ml (78,7-1416,5), p=0,792). No correlation obtained between VEGF-A and corneal neovascular area (first visit r -0,28, p=0,212, fourth week r -0,04 p=0,855). Conclusion: The difference of neovascular area at the fourth week could be due to proangiogenic factor of bacteria through its effect on VEGF-A and antiangiogenic factor in fungi that may overcome VEGF-A effect. Further study is needed to confirm the antiangiogenic factor that fungi possess."

"ABSTRAKTujuan: Mengevaluasi efek injeksi anti-VEGF intravitreal, bevacizumab, terhadap kadar cystatin C plasma dan VEGF plasma dan meninjau korelasi antara kedua faktor tersebut.Metodologi: Penelitian ini merupakan studi eksperimental satu kelompok dengan sampel dipilih secara konsekutif dari populasi terjangkau. Pemeriksaan oftalmologi lengkap, tekanan darah, laboratorium darah perifer lengkap, dan pemeriksaan kadar cystatin C plasma dan VEGF plasma dilakukan pada subjek sebelum injeksi dan 14 hari pasca injeksi bevacizumab intravitreal dosis 1,25 mg (0,05 cc).Hasil: 33 subjek dilibatkan dalam penelitian ini. Dari seluruh subjek, 63,6% adalah perempuan dan 36,4% adalah laki-laki dengan usia rata-rata 66,4 ± 8,3 tahun. Tidak terdapat perbedaan bermakna secara statistik antara kadar VEGF plasma pre dan pasca injeksi (p=0,339). Tidak terdapat perbedaan bermakna secara statistik antara kadar cystatin C plasma pre dan pasca injeksi (p=0,709). Uji korelasi antara perubahan VEGF plasma dengan perubahan cystatin C plasma pre dan pasca injeksi menunjukkan korelasi yang tidak bermakna (p=0,142).Kesimpulan: Kadar cystatin C plasma tidak berubah secara signifikan pre dan pasca injeksi bevacizumab pada injeksi satu kali. Tidak ditemukan adanya korelasi antara penurunan kadar VEGF plasma dengan peningkatan kadar cystatin C pada pasien AMD neovaskuler pasca injeksi bevacizumab.

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ABSTRACTObjective: To evaluate the effect of intravitreal bevacizumab injection on plasma cystatin C and plasma VEGF levels and the correlation between the two factors.Methodology: This research was a single arm study with samples selected consecutively from an assigned population. Ophthalmology examinations, blood pressure, complete blood count, and assessments of plasma cystatin C and plasma VEGF levels were carried out on subjects before and 14 days after intravitreal bevacizumab injection of 1.25 mg (0.05 cc).Results: 33 subjects were included in this study. Of all subjects, 63.6% were women and 36.4% were men with an average age of 66.4±8.3 years. There was no statistically significant difference between pre and post injection plasma VEGF and plasma cystatin C levels (p=0.339 and 0.709 respectively). Correlation test between changes in plasma VEGF with changes in plasma cystatin C pre and post injection showed no significant correlations (p=0.142).Conclusion: Plasma cystatin C levels did not change significantly before and after injection of bevacizumab on one-time injection. No correlation was found between decreasing plasma VEGF levels and increasing levels of cystatin C in patients with neovascular AMD after bevacizumab injection."

"Penelitian ini bertujuan membandingkan luaran tajam penglihatan dan ketebalan makula sentral paska terapi loading dose bevacizumab intravitreal pasien age-related macular degeneration AMD neovaskular antara yang memiliki karakter predominan subretinal dengan intraretinal fluid. Metode yang digunakan adalah Uji klinis pre-post intervensi bevacizumab intravitreal pada dua kelompok AMD yang berbeda. Sampling secara konsekutif membagi 38 subyek penelitian menjadi 2 kelompok AMD dengan hasil OCT predominan subretinal fluid SRF 20 mata dan intraretinal fluid IRF 18 mata . Evaluasi luaran tajam penglihatan, ketebalan makula sentral, dan perubahannya dilakukan sepanjang dan sesudah loading dose selesai. Rerata tajam penglihatan pada baseline berbeda signifikan antara kelompok SRF 56,41 huruf ETDRS dan IRF 43,72 huruf ETDRS . Paska loading dose tidak terdapat perbedaan bermakna dari perubahan tajam penglihatan maupun ketebalan makula sentral antara kedua kelompok, tetapi luaran tajam penglihatan pada kelompok SRF tetap lebih tinggi dan didapati ketebalan makula sentral kelompok SRF lebih rendah secara signifikan. AMD neovaskular baik dengan gambaran SRF maupun IRF saat baseline, mendapat manfaat yang sebanding dari terapi bevacizumab intravitreal meskipun rerata tajam penglihatan dan penurunan ketebalan makula sentral lebih baik jika terdapat SRF.

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This study aimed to compare visual acuity VA and central macular thickness CMT outcome of loading dose intravitreal bevacizumab treatment between neovascular age related macular degeneration AMD patients with character of predominant subretinal and intraretinal fluid. This study performed pre post interventional clinical study of two different AMD groups, treated with loading dose intravitreal bevacizumab. Consecutive sampling distributed 38 samples based on OCT into group with predominant subretinal fluid SRF group 20 eyes and intraretinal fluid IRF 18 eyes VA, CMT, and their changes were evaluated during and after loading dose was completed. Mean VA at baseline eventually was significantly different where SRF group 56,41 letters were better than IRF group 43,72 letters . No statistically significant difference of mean VA change or CMT change between group, however VA in SRF group remained higher and CMT in SRF group were lower than IRF group. Neovascular AMD, with both SRF and IRF at baseline, benefits from loading dose intravitreal bevacizumab treatment although mean visual acuity and mean central retinal thickness are better in those with SRF."