036) and group 3 (treatment-naïve anti-VEGF injections + no planned supplement intervention; P = .014), but not when compared with group 4 (control; P = .215; Figure 2). Both wet AMD groups not taking omega-3 supplementation (groups 2 and 3) had similar levels of vitreous VEGF-A
(P = .758). Group 3 (treatment naïve) had significantly higher vitreous levels of VEGF-A when compared with nonvascular ocular pathologic features group 4 Idelalisib (controls; P = .039; Figure 2). Seven of 9 patients in group 1 had concentrations of vitreous VEGF-A lower than all but 1 of the patients in group 2 ( Figure 2). Analysis of plasma levels of VEGF-A revealed no significant change between groups (P = .736; Figure 3). Similarly, although values for CFT tended toward improvement,
no significant benefit was noted with omega-3 supplementation in the sample population investigated in this pilot study (P = .211; Figure 4). In this pilot clinical trial, we Ribociclib investigated the influence of omega-3 supplementation on VEGF-A levels in the vitreous of patients undergoing anti-VEGF treatment for wet AMD and noted a significant decrease of VEGF-A in patients receiving omega-3. Dietary intake of omega-3 LCPUFAs and its influence on processes implicated in pathologic retinal angiogenesis has been proposed.18 We previously reported on the pronounced anti-angiogenic effects of certain omega-3 LCPUFA metabolites such as 4-hydroxy-docosahexaenoic acid (a metabolite produced via the 5-lipoxygenase pathway and acting through the peroxisome proliferator-activated nearly receptor). We also demonstrated that increased omega-3 LCPUFA
dietary intake reduces pathologic angiogenesis in experimental animal models of neovascular retinopathies.27, 29 and 32 Our previous genetic work in humans extended these findings to support the influence of omega-3 activated pathway on angiogenesis in wet AMD patients via complement and VEGF signaling systems.33 In the time frame of the current human study, the effects of omega-3 supplementation were exclusive to modulating vitreous levels of VEGF-A in proximity of the site of neovascularization, but not on systemic levels as determined by analysis of plasma. Interestingly, despite the significantly lower levels of VEGF-A in the vitreous of group 1, CFT values were similar to those of group 2 (after an average of 7 prior anti-VEGF injections) and of group 3 (Figure 3 and Table). In accordance with recent work in diabetic macular edema by Sonoda and associates, our findings also demonstrated a lack of correlation between CFT values and vitreous levels of VEGF in patients with active wet AMD (data not shown).34 These data agree with the notion that other factors besides VEGF-A may contribute to disease activity in wet AMD and that combination therapy with other agents is likely necessary in many patients to completely stall CNV activity and promote regression.