Anterior segment changes following intravitreal bevacizumab injection for treatment of neovascular glaucoma

Canut, MI; Alvarez, Aurelio Pérez; Nadal, Jeroni; Abreu, R. F.; Abreu, J.A.; Pulido, J. S.

doi:10.2147/opth.s17350

Cited by 12 publications

(9 citation statements)

References 22 publications

(19 reference statements)

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“…14 At the same time as our observations, there have been case reports describing fibrovascular tissue contraction after the injection of bevacizumab, inducing angle closure and a consequent increase in IOP. 10,11 In a study of 5 cases of NVG treated with bevacizumab, our group 10 found regression of neovascularization and IOP control. However, 3 of these cases showed increased IOP 48 hours after injection, which required cycloablation for control.…”

Section: Discussionmentioning

confidence: 94%

Neovascular Glaucoma Treatment With Extraction of Anterior Chamber Fibrovascular Tissue

et al. 2013

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Compared with other types of glaucoma, neovascular glaucoma (NVG) has poor visual field prognosis. Its pathogenesis involves retinal ischemia, which induces the formation of new vessels and fibrous tissue in the root and stroma of the iris; these act mechanically on the angle, causing its closure and subsequent ocular hypertension. 1,2 In the initial stages, intraocular pressure (IOP) is usually normal, so therapeutic measures are primarily directed at treating the cause of ischemia. 3,4 Panretinal ablation and, more recently, administration of antibody to vascular endothelial growth factor (anti-VEGF), 5-9 are the most widely accepted techniques used to induce neovascular regression. However, after the angle closure phase, IOP elevation requires immediate treatment (with corticosteroids or cycloplegic or hypotensive agents). This is followed by treatment of the pathogenic causes to control the process of neovascularization, and finally by treatment of residual glaucoma (with filtering surgery, drainage devices, or cyclodestructive procedures). 3,4 Etiological treatment is intended to resolve the causes of retinal ischemia that lead to the formation and progression of neovessels, in combination with anti-VEGF treatment. 5-9 However, various studies have reported IOP decompensation after the administration of anti-VEGF secondary to angle closure. 10,11 T h e s u r g i c a l t e c h n i q u e d e s c r i b e d h e r e i n v o l v e s removal of fibrovascular tissue at the level of the iris and angle in order to release the angle and facilitate drainage of aqueous humor, thereby controlling IOP.

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Section: Discussionmentioning

confidence: 94%

Neovascular Glaucoma Treatment With Extraction of Anterior Chamber Fibrovascular Tissue

et al. 2013

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“…İris neovaskülarizasyonu varlığında intravitreal bevacizumab enjeksiyonu sonrası açıdaki damarların hızla gerilemesi ile ilişkili olarak bazı hastalarda 1-2 gün içerisinde açının daralması hatta tamamen kapanması söz konusu olabilmektedir (7). İntravitreal enjeksiyon sonrası "akut" açı kapanması glokomu ise literatürde sadece bir gözde rapor edilmiştir (8).…”

Section: Discussionunclassified

Effect of Intravitreal Bevacizumab Injection on Iridocorneal Angle Width

Ağca¹,

Doğan²,

Altan³

et al. 2013

Istanbul Med J

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Amaç: İntravitreal bevacizumab enjeksiyonun iridokorneal açı genişliğine etkisinin incelenmesi.Yöntemler: Diyabetik makula ödemi nedeniyle intravitreal becavizumab enjeksiyonu planlanan ve gonyoskopisinde iridokorneal patoloji saptanmayan ardışık 15 hastanın 15 gözüne 0,05 mL bevacizumab enjeksiyondan hemen önce ve enjeksiyondan hemen sonra RTVue (OptoVue Inc., Fremont, CA, USA) cihazı ile temporal kadranı değerlendirecek şekilde ön segment optik koherens tomografisi (ÖS-OKT) çekilerek Schwalbe hattı hizasında açı açıklığı mesafesi (SH-AAM) ölçüldü ve enjeksiyonun bu parametre üzerine etkisi incelendi. Bulgular:Hastaların 10'u erkek 5'i kadın ve yaş ortalaması 58,4±5,5 idi. Hastaların tamamında enjeksiyon öncesi açı genişliği Shaffer sınıfla-masına göre evre 2 ve üzerindeydi. Enjeksiyon öncesi ortalama SH-AAM 396,5±212,6 µ iken enjeksiyon sonrası ortalama SH-AAM 364,3±215,4 µ olarak saptandı. Aradaki fark istatistiksel olarak anlamlı değildi (p>0,05). Sonuç:İridokorneal açıyı etkileyen bir patolojisi bulunmayan ve açı geniş-liği Shaffer sınıflamasına göre evre 2 ve üzerinde olan hastalarda 0,05 mL intravitreal enjeksiyonun iridokorneal açı genişliğine ÖS-OKT'si ile tespit edilebilir bir etkisi yoktur.Anahtar Kelimeler: İntravitreal enjeksiyon, iridokorneal açı, optik koherens tomografisi, Schwalbe hattı, SH-AAM Objective: To evaluate the effect of intravitreal bevacizumab injection on iridocorneal angle width.Methods: Diabetic macular edema patients who l undergo intravitreal bevacizumab injection were included in the study if they had no iridocorneal angle pathologies on gonioscopy. Anterior segment optical coherence tomography was performed with RTVue (OptoVue Inc., Fremont, CA, USA) on 15 eyes of 15 patients to measure the angle opening distance at the Schwalbe's line (SL-AOD) in the temporal quadrant before and just after the injection of 0.05 mL bevacizumab. The effect of the intravitreal injection on this parameter was evaluated.Results: 10 patients were male and 5 were female. The mean age was: 58.4±5.5 years. All patients had Shaffer Grade 2 or wider angles in all the quadrants before the injection. Mean SL-AOD before the injection was 396.5±212.6 µ and mean SL-AOD after the injection was 364.3±215.4 µ. The difference was not statistically significant (p>0.05). Conclusion: Intravitreal injection of 0,05 mL bevacizumab has no detectable effect on anterior segment OCT images of iridocorneal angles in patients who have Shaffer Grade 2 or wider angles.Key Words: Intravitreal injection, iridocorneal angle, optical coherence tomography, Schwalbe's line, SL-AOD GirişGünümüzde intravitreal enjeksiyonların sıklığı özellikle diyabetik makula ödemi ve koroidal neovasküler membranların tedavisinde intravitreal bevacizumab ve ranibizumab kullanımının yaygınlaşması ile geçmiş yıllara nazaran dramatik biçimde artmış ve artmaya da devam etmektedir.Bu çalışmada iridokorneal açıyı etkileyen bir patolojisi bulunmayan hastalarda 0,05 mL intravitreal bevacizumab enjeksiyonunun açıya etkisini enjeksiyondan hemen sonra çekilen...

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“…Die in der Literatur beschriebenen IOD-Werte nach Zyklokryokoagulation lagen 1 Woche postoperativ bei 23,6 (± 11) mmHg und 1 Jahr postoperativ bei 8,2 (± 11,5) mmHg. Dies zeigte im Vergleich zu den präoperativen Werten (durchschnittlicher IOD präoperativ: 43,6 mmHg) eine signifikante Senkung [17,20]. Die Ergebnisse der Studie von Tzamalis et al (2011) zeigten eine signifikante IOD-Senkung von 46% 1 Jahr nach der Anwendung der Zyklophotokoagulation und von 54,1 % 1 Jahr nach der Behandlung mit Zyklokryokoagulation.…”

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“…Die intrakamerale oder intravitreale Anwendung von Bevacizumab führte jedoch zu einer schnellen Regression der Rubeosis iridis[18] und dadurch zu einer Drucksenkung. Die Langzeitauswirkungen auf die Regulation des IODs waren aber in diesen Studien nicht erfreulich[16][17][18]. Daher haben wir die intravitreale Anwendung von Bevacizumab mit der Zyklokryokoagulation kombiniert, um eine langfristige Druckregulierung zu erreichen.…”

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