الفهرس 
Classification of diabetic retinopathyOnly 14 pages are availabe for public view
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Abstract
Introduction: Diabetic retinopathy is a leading cause of blindness at its late stages, many theories have been proposed to explain its pathology, the recent one is VEGF theory which explain the all stages of diabetic retinopathy including diabetic maculopathy. The aim of the work: The aim of this work is evaluation of the Vascular Endothelial Growth Factor (VEGF) as an indicator of the degree of severity in cases of diabetic retinopathy, correlating its levels in both serum and vitreous with the degree of retinal affection . Patients and Methods: This study involved 120 patients undergo vitreoretinal surgery, vitreous and blood samples were taken at the start of vitrectomy, the patients were classified into three groups 1)proliferative group 40 patients. 2)non proliferative group ,40 patients and 3) control group 40 patients. Measurement of VEGF concentrations in all. vitreous and blood samples was done using special kits (Human Accucyte VEGF kits) , measurement of optical density and corresponding concentrations was done through ELISA apparatus. Statistical analysis of the data was done. Results:There were statistically significant increase of VEGF ( vitreous and serum) in proliferative group (mean=176.1ng/ml and 128.881ng/ml)than non proliferative( 60.281ng/ml and 33.281ng/ml)and both higher than control group(4.53 ng/ml and 4.22 ng/ml). The highest levels were in PDR with tractional retinal detachment (mean vitreous samples =225.18 ng/ml and mean serum samples =155.1 ng/ml). Increasing the VEGF concentrations progressively with the progressing grades of NPDR , the highest level was in very severe NPDR (mean vitreous =104.0 ng/ml and mean serum =66.0 ng/ml).There was high VEGF concentration in diabetic patients with maculopathy than diabetics without maculopathy (mean=82.1 ng/ml and 49.8 ng/ml respectively). High VEGF in diabetic patients under insulin therapy than oral therapy , VEGF levels were higher in diabetic patients associated with hypertension (mean=183.71 ng/ml in PDR and 61.70 ng/ml in NPDR) than non hypertensive diabetic patients (mean=169.62 ng/ml in PDR and 59.81 ng/ml in NPDR). There was non significant correlation between VEGF concentrations and age of patients, duration of diabetes and blood sugar levels. Vitreous VEGF levels were higher than serum VEGF in both diabetic groups with strong positive correlation between vitreous and serum levels. Conclusions: This study concluded that VEGF can be used as an indicator for the severity of diabetic retinopathy especially when associated with maculopathy, hypertension and patients receiving insulin therapy . Vitreous VEGF is more significant than serum VEGF for prediction of retinopathy. This study also cocludes that tight glycemic control together with an effective program of ophthalmic examination and follow up with close association with medical doctors are the keys in preventing or retarding the progression of the disease. This study recommended new researches for studying VEGF in aqueous, urine and serum to be non harmful samples for detection of high levels of VEGF, also recommended new researches for studying the anti VEGF (VEGF inhibitors) to evaluate their role in management of PDR