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: 2.43). 07/2012; DOI: 10.1097/IJG.0b013e318259aec4
Source: PubMed

ABSTRACT PURPOSE:: 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). METHOD:: 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. RESULTS:: 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). CONCLUSIONS:: Intravitreal bevacizumab (Avastin) with PRP followed by Ahmed valve implantation appears to be effective in the management of NVG.

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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.
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