Adjunctive Intravitreal Bevacizumab-Combined Trabeculectomy Versus Trabeculectomy Alone in the Treatment of Neovascular Glaucoma

Chen, Chih-Hsin; Lai, Ing‐Chou; Wu, Pei-Chang; Chen, Yung-Jen; Chen, Yi-Hao; Lee, Jong‐Jer; Liu, Ya-Chi; Kuo, Hsi-Kung

doi:10.1089/jop.2009.0055

Cited by 27 publications

(18 citation statements)

References 34 publications

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“…Most of them focused on intravitreal use of anti-VEGF for patients with neovascular glaucoma, reporting a significant improvement in surgical outcomes, such as lower incidence of hyphema and better IOP control, especially in the short-term follow-up [12][13][14][15]. Regarding the scant data published on primary glaucoma patients, our results are in agreement with those from Grewal et al [23].…”

Section: Discussionsupporting

confidence: 90%

“…Few studies have investigated the use of subconjunctival bevacizumab for the management of postoperative fibrosis following trabeculectomy [10][11][12][13][14][15]. Most of them focused on intravitreal use of anti-VEGF for patients with neovascular glaucoma, reporting a significant improvement in surgical outcomes, such as lower incidence of hyphema and better IOP control, especially in the short-term follow-up [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Intravitreal administration of bevacizumab (Avastin; Genentech, San Francisco, CA, USA), one of the most commonly used anti-VEGF agents in ocular diseases, has been shown to improve trabeculectomy success rates in eyes with secondary glaucomas, more specifically, in those with neovascular glaucoma [12][13][14][15]. In this study we sought to investigate subconjunctival bevacizumab as an adjuvant in first-time filtration surgery for patients with primary glaucomas.…”

Section: Introductionmentioning

confidence: 99%

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Subconjunctival bevacizumab as an adjuvant in first-time filtration surgery for patients with primary glaucomas

Biteli

Prata

2013

Int Ophthalmol

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To investigate subconjunctival bevacizumab as an adjuvant in first-time glaucoma filtration surgery, we conducted a non-comparative, interventional case series, enrolling consecutive patients with uncontrolled primary glaucomas. All patients underwent trabeculectomy with mitomycin C and received a 1.25 mg subconjunctival bevacizumab injection at completion of the surgery. Main outcome measurements were success rates, bleb morphology [standardized classification based on vascularity (0-1), extension (0-1) and height (0-1); ranging from 0 to 3 (0 = poor; 1 = regular; 2 = good; 3 = excellent)] and post-operative complications. Twenty-five eyes from 25 patients (mean age 64.3 ± 12.8 years) were included. After a mean follow-up of 16.7 ± 6.1 months, mean intraocular pressure (IOP) was significantly reduced from 22.7 ± 10.8 to 12.9 ± 4.3 mmHg at the last follow-up (p < 0.01). Complete success rates at 12 months ranged between 71 and 88 %, while qualified success rates ranged between 84 and 96 %, depending on the criterion adopted (the strictest success criterion was defined as IOP between 6 and 12 mmHg). Blebs were graded as good or excellent in 80 % of the cases. No serious post-operative complication or avascular blebs were observed. These mid-term results suggest subconjunctival bevacizumab as a safe and effective adjuvant in first-time filtration surgery for primary glaucoma patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subconjunctival bevacizumab as an adjuvant in first-time filtration surgery for patients with primary glaucomas

Biteli

Prata

2013

Int Ophthalmol

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“…Similar percentages of intraoperative bleeding during glaucoma drainage device insertion without IVB have been reported by Eid et al 38 and Kim et al, 10 while Takihara and coworkers 39 showed a much higher prevalence during trabeculectomy, with 59 of 101 eyes (58%) developing a hyphema. In a recent study by Chen and coworkers, 40 the incidence of intraoperative hyphema was doubled in NVG eyes undergoing trabeculectomy without adjunctive IVB (1 of 14 eyes [7%] in the IVB group vs 4 of 28 eyes [14%] in the untreated group). Our data add to the suggestion that the preoperative use of IVB may reduce the bleeding complications associated with operations in eyes with NVG.…”

Section: Commentmentioning

confidence: 99%

Intravitreal Bevacizumab in Refractory Neovascular Glaucoma

Kotecha

Spratt²,

Ogunbowale³

et al. 2011

Arch Ophthalmol

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To examine the efficacy of intravitreal bevacizumab for pain relief in eyes with refractory neovascular glaucoma.Methods: In this prospective case series, 52 eyes with neovascular glaucoma were administered intravitreal bevacizumab, 1.25 mg, and monitored for 6 months. The primary outcome measure was change in subjective pain score. Intraocular pressure and iris neovascularization were evaluated at each visit. Surgical intervention for control of intraocular pressure was performed according to clinical need. Results: Forty-two patients (44 eyes) completed the 6-month follow-up. Subjective pain score was reduced significantly 1 week after intravitreal bevacizumab injection and lasted throughout the follow-up period (median [interquartile range]: baseline, 3 [0-6]; week 1, 1 [0-3]; month 1, 0 [0-1]; month 3, 0 [0-1]; and month 6, 0 [0-0]; Kruskal-Wallis 2 31.03; P Ͻ.001). A rapid, yet relatively transient, reduction in iris neovascularization was also noted (iris neovascularization grade at baseline, 4.0 [3-4]; week 1, 2.5 [1-4]; month 1, 2.0 [1-4]; month 3, 3.0 [2-4]; and month 6, 3.0 [2-4], 2 23.33;PϽ.001). Four eyes (8%) required more than 1 injection to facilitate further intraocular surgery.Conclusions: Intravitreal bevacizumab is a useful adjunct in the management of refractory neovascular glaucoma, producing rapid relief of pain. However, we found no evidence to suggest that intravitreal bevacizumab lowers intraocular pressure in eyes with angle closure; conventional medical, laser, and surgical treatment are still needed in these eyes.

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“…[11][12][13][14] Then, some comparative studies were carried out to assess the efficacy of trabeculectomy with and without preoperative IVB; however, the results were inconsistent and no consensus could be reached on the effect of preoperative IVB injection before trabeculectomy for NVG. [15][16][17] Furthermore, the follow-up periods in all of these studies were relatively short, generally not exceeding 1 year. Long-term (>3 y) outcomes have not been reported yet, and it remains unknown whether the treatment procedure might be effective over the long term.…”

mentioning

confidence: 99%

Long-term Outcomes After Preoperative Intravitreal Injection of Bevacizumab Before Trabeculectomy for Neovascular Glaucoma

Kobayashi

Inoue²,

Yamane³

et al. 2016

Journal of Glaucoma

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Adjunctive Intravitreal Bevacizumab-Combined Trabeculectomy Versus Trabeculectomy Alone in the Treatment of Neovascular Glaucoma

Abstract: Intravitreal bevacizumab might be a useful adjunctive therapy in addition to trabeculectomy in the management of NVG. Large controlled randomized studies for treatment of bevacizumab on NVG are warranted.

Cited by 27 publications

References 34 publications

Subconjunctival bevacizumab as an adjuvant in first-time filtration surgery for patients with primary glaucomas

Subconjunctival bevacizumab as an adjuvant in first-time filtration surgery for patients with primary glaucomas

Intravitreal Bevacizumab in Refractory Neovascular Glaucoma

Long-term Outcomes After Preoperative Intravitreal Injection of Bevacizumab Before Trabeculectomy for Neovascular Glaucoma

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