Efficacy of Intravitreal Bevacizumab With Panretinal Photocoagulation Followed by Ahmed Valve Implantation in Neovascular Glaucoma

Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkeya, Egypt.
Journal of glaucoma (Impact Factor: 2.11). 07/2012; 22(9). DOI: 10.1097/IJG.0b013e318259aec4
Source: PubMed


To establish the efficacy and safety of intravitreal bevacizumab (Avastin) with panretinal photocoagulation (PRP) followed by Ahmed valve implantation in the treatment of neovascular glaucoma (NVG).

This prospective randomized study included 40 eyes of 40 patients with refractory NVG. Twenty eyes underwent Ahmed valve implantation with intravitreal bevacizumab (Avastin) (1.25 mg in 0.5 mL) and PRP and 20 eyes were managed by Ahmed valve and PRP (control group). The follow-up period was 18 months.

Complete success was defined as an intraocular pressure ≤ 21 mm Hg. Qualified success was considered when the above criteria were fulfilled but with additions of antiglaucoma topical medical treatment. The results revealed 95% total success (75% complete success and 20% qualified success) in the first group in which Avastin-augmented Ahmed valve was performed compared with 50% total success in the control group in which Ahmed valve implantation was performed alone (25% complete success and 25% qualified success).

Intravitreal bevacizumab (Avastin) with PRP followed by Ahmed valve implantation appears to be effective in the management of NVG.

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    ABSTRACT: Neovascular glaucoma is a refractory glaucoma associated with a significant risk of blindness. The first line of treatment is ablation of retina to lessen retinal ischemia. The combination of bevacizumab and panretinal photocoagulation is effective in preventing progression of neovascular glaucoma. The adjunctive use of bevacizumab also reduces the risk of postoperative hyphema after filtering surgery. Prior vitrectomy in these eyes more frequently results in bleb failure after trabeculectomy. Advances in minimally invasive vitreous surgery reduce conjunctival scar formation, which can be beneficial if further filtering surgery is required. Pars plana implantation of glaucoma drainage devices is also an option for the reduction of intraocular pressure in vitrectomized eyes with neovascular glaucoma.
    Expert Review of Ophthalmology 01/2014; 9(1). DOI:10.1586/17469899.2014.879825
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    ABSTRACT: PurposeTo evaluate the efficacy and safety of intravitreal bevacizumab (IVB) in eyes with neovascular glaucoma (NVG) undergoing Ahmed glaucoma valve (AGV) implantation.Methods This was a multicentre, prospective, randomized clinical trial that enrolled 40 patients with uncontrolled neovascular glaucoma that had undergone panretinal photocoagulation and required glaucoma drainage device implantation. Patients were randomized to receive IVB (1.25 mg) or not during Ahmed valve implant surgery. Injections were administered intra-operatively, and 4 and 8 weeks after surgery.ResultsAfter a mean follow-up of 2.25 ± 0.67 years (range 1.5–3 years), both groups showed a significant decrease in IOP (p < 0.05). There was no difference in IOP between groups except at the 18-month interval, when IOP in IVB group was significantly lower (14.57 ± 1.72 mmHg vs. 18.37 ± 1.06 mmHg – p = 0.0002). There was no difference in survival success rates between groups. At 24 months, there was a trend to patients treated with IVB using less antiglaucoma medications than the control group (p = 0.0648). Complete regression of rubeosis iridis was significantly more frequent in the IVB group (80%) than in the control group (25%) (p = 0.0015).Conclusions Intravitreal bevacizumab may lead to regression of new vessels both in the iris and in the anterior chamber angle in patients with neovascular glaucoma undergoing Ahmed glaucoma valve implantation. There is a trend to slightly lower IOPs and number of medications with IVB use during AGV implantation for neovascular glaucoma.
    Acta ophthalmologica 07/2014; 93(1). DOI:10.1111/aos.12493 · 2.84 Impact Factor
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    ABSTRACT: Aim: To explore the efficacy of preoperative intravitreal bevacizumab (IVB) injection combined with Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG). Methods: This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure (IOP) number of anti-glaucoma medications, visual acuity (VA), surgical success rates, and complications were recorded. Results: After AGV implantation, IOP was 18.2±4.0 mm Hg, 15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36mo, significantly decreased compared with pre-IOP (P<0.01). The number of anti-glaucoma medications was 0.9±0.5, 0.8±0.9 and 0.8±0.6 at 6, 12 and 36mo, significantly decreased compared to pre-treatment (P<0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%, 74.1% and 71.0% at 12, 24 and 36mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity <2/400 (P<0.05). Post-operative complications occurred in 8 eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes. Conclusion: The procedure of preoperative IVB and AGV implantation should be one of treatments for NVG because of its safety and effectiveness.
    International Journal of Ophthalmology 10/2014; 7(5):837-42. DOI:10.3980/j.issn.2222-3959.2014.05.18 · 0.12 Impact Factor
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