gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Aqueous humor concentration of plasminogen activator inhibitor (PAI)-1 in glaucoma and cataract patients and its influence on postoperative bleb scarring after primary trabeculectomy

Meeting Abstract

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  • corresponding author I. Wimmer - Augenklinik der Julius-Maximilians-Universität Würzburg, Würzburg
  • R. Fuchshofer - Anatomisches Institut II der Friedrich Alexander Universität Erlangen, Erlangen
  • F. Grehn - Augenklinik der Julius-Maximilians-Universität Würzburg, Würzburg

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 090

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Veröffentlicht: 22. September 2004

© 2004 Wimmer et al.
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Plasminogen Activator Inhibitor-1 (PAI-1) acts as a main regulator of the fibrinolytic system and modulates extracellular matrix proteolysis. High concentration of PAI-1 inhibits matrix metalloproteinases (MMP) function by decreasing plasmin and subsequently extracellular matrix degradation, which promotes tissue scarring. The overexpression of PAI-1 has been found to correlate with extensive tissue scarring i.e. in the skin, lung and kidney. In the porcine eye, PAI-1 has been found in the ciliary epithelium and aqueous humor and also in the posterior segment of the eye. We investigated the concentration of PAI-1 in the aqueous humor of cataract and glaucoma patients and the correlation to postoperative bleb scarring after trabeculectomy.


27 primary open angle glaucoma (POAG) patients, 17 exfoliation (XFS) glaucoma patients, 7 pigment glaucoma patients and 24 cataract patients were recruited in consecutive series in this prospective study. All glaucoma patients underwent primary trabeculectomy by one surgeon. Aqueous humor (40-180 μl) was sampled at the beginning of surgery and analysed for PAI-1 concentration by ELISA (American Diagnostics). Cataract patients served as controls. Standardized masked bleb assessment for signs of scarring was performed postoperatively.


In exfoliation glaucoma, PAI-1 concentration was significantly increased (mean 4.33±2.65 μg/ml) as compared to cataract patients (mean 2.69±SD 1.10 μg/ml, P= 0.009) and still higher as in POAG patients (mean 3.15±SD 1.5 μg/ml, P= 0.066) but close to normal level in pigment glaucoma (mean 2.76±SD 0.72 μg/ml). Concerning postoperative bleb scarring in POAG we found higher concentration of PAI-1 in the eyes with scarred blebs (mean 3.58±SD1.89 μl, n=13) as compared to favourable looking blebs (mean 2.76±SD 0.96 μl, n=14). In exfoliation glaucoma, this difference was even more pronounced (scarred blebs: mean 5.78±SD 3.66 μl, n=7, favourable looking blebs: mean 3.32±SD 0.89 μl, n=10, P= 0.057 student t-test)


PAI-1 concentration in the human aqueous humor is elevated in POAG and more so in XFS glaucoma as compared to cataract patients. We found an increased scarring risk of the bleb after trabeculectomy in patients with higher PAI-1 concentrations particulary in XFS glaucoma, where PAI-1 could be used as a prognostic marker for postoperative bleb scarring.