Efficacy of Intravitreal Bevacizumab With Panretinal Photocoagulation Followed by Ahmed Valve Implantation in Neovascular Glaucoma.
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: We studied the intermediate-term clinical experience with the Ahmed Glaucoma Valve implant (New World Medical, Inc, Rancho Cucamonga, California). In this multicenter, retrospective case series, we studied 159 eyes (144 patients) treated with the Ahmed Glaucoma Valve with a mean +/- SEM (standard error of mean) follow-up of 13.4 +/- 0.7 months (range, 4 to 44 months). The mean +/- SEM age was 60.9 +/- 1.9 years (range, 0.1 to 103 years). Surgical success was defined as intraocular pressure less than 22 mm Hg and greater than 5 mm Hg without additional glaucoma surgery and without loss of light perception. Postoperative use of antiglaucoma medications was not a criterion for success or failure. The definition of hypotony was intraocular pressure of 5 mm Hg or less in two consecutive visits. Intraocular pressure was reduced from a mean of 32.7 +/- 0.8 mm Hg before surgery to 15.9 +/- 0.6 mm Hg (P < .0001) at the most recent follow-up after surgery. The number of antiglaucoma medications was decreased from 2.7 +/- 0.1 before surgery to 1.1 +/- 0.1 after surgery (P < .0001). The cumulative probability of success was 87% at 1 year and 75% at 2 years after surgery (Kaplan-Meier life-table analysis). Postoperatively, 24 (15%) of 159 eyes had intraocular pressure greater than or equal to 22 mm Hg. The visual acuity was improved or within one Snellen line in 131 eyes (82%). Complications occurred in 75 eyes (47%), the majority of which did not affect surgical outcome. The most common complication was obstruction of the tube, which was observed in 17 eyes (11%). Transient postoperative hypotony was found in 13 eyes (8%). The Ahmed Glaucoma Valve implant is effective in lowering intraocular pressure, and postoperative hypotony is not commonly associated with this implant.American Journal of Ophthalmology 02/1999; 127(1):27-33. · 3.63 Impact Factor
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ABSTRACT: To determine whether intravitreal bevacizumab could improve optical coherence tomography and visual acuity outcomes in a patient with neovascular age-related macular degeneration who was responding poorly to pegaptanib therapy, an intravitreal injection of bevacizumab (1.0 mg) was given. Within 1 week, optical coherence tomography revealed resolution of the subretinal fluid, resulting in a normal-appearing macular contour. The improved macular appearance was maintained for at least 4 weeks, and visual acuity remained stable. No inflammation was observed. An intravitreal injection of bevacizumab may provide an effective, safe, and inexpensive option for patients with age-related macular degeneration who are losing vision secondary to macular neovascularization.Ophthalmic Surgery Lasers and Imaging 01/2005; 36(4):331-5. · 1.46 Impact Factor
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ABSTRACT: Angiogenesis has a causal role in many diseases, including neovascular age-related macular degeneration (AMD). Identification of key regulators of angiogenesis, including vascular endothelial growth factor (VEGF), fibroblast growth factor 2, pigment epithelium-derived growth factor, angiopoietins and extracellular matrix molecules, has facilitated the development of novel therapeutic agents that target the underlying pathological angiogenic process. Among these, VEGF serves as a "master switch" for many ocular neovascular conditions through its promotion of endothelial cell proliferation and survival, vascular permeability and ocular inflammation. Two anti-VEGF agents are now clinically available: bevacizumab, an antibody for metastatic colorectal cancer, and pegaptanib sodium, an aptamer for neovascular AMD. Unlike bevacizumab, which binds all VEGF isoforms, pegaptanib targets only VEGF165, the isoform responsible for pathological ocular neovascularization and thus an ideal target for treatment of AMD. Although other therapies targeting angiogenesis in AMD are in clinical development, to date, pegaptanib is the only therapy approved by the Food and Drug Administration of the United States for the treatment of all neovascular AMD and represents a valuable addition to the hitherto limited options available for patients.Canadian Journal of Ophthalmology 07/2005; 40(3):352-68. · 1.15 Impact Factor