Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma

Tang, Min; Fu, Yang; Wang, Ying; Zheng, Zhi; Fan, Ying; Sun, Xiaodong; Xu, Xun

doi:10.1186/s12886-016-0183-7

Cited by 33 publications

(24 citation statements)

References 20 publications

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“…The evidence suggests that IVB injection of an anti-VEGF agent combined with PRP laser treatment may be particularly beneficial for early-onset elevated IOP prior to glaucoma surgery to prevent intraoperative bleeding. 15,28,29 Further glaucoma surgery might be selected, not only with a glaucoma drainage device, which is expensive, but the potency of a trabeculectomy with mitomycin C should be well-thought-out.¹⁹ However, a carefully considered treatment plan must be established according to the individual characteristics of NVG.³⁰…”

Section: Discussionmentioning

confidence: 99%

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

et al. 2019

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BACKGROUND The aim of this study was to determine the levels of vascular endothelial growth factor (VEGF) in the aqueous humor and the effect of intravitreal anti-VEGF injection combined with panretinal photocoagulation (PRP) on the management in diabetes mellitus (DM) patients with neovascular glaucoma (NVG). METHODS This study was a prospective, interventional study in DM patients with NVG. Paracentesis followed by intravitreal bevacizumab (IVB) injection was performed in all eyes. The concentration of VEGF obtained from paracentesis was measured. In week-1, the intraocular pressure (IOP), sectorial iris neovascularization (NVI), and visual acuity were documented, and management was continued with PRP laser over a period of 1 week. All parameters and additional interventions performed after PRP were also recorded. RESULTS A total of 18 eyes from 17 patients were studied. The mean (SD) level of VEGF in the aqueous humor was 3,864 (1,468) pg/ml, and the mean (SD) of initial IOP was 39 (10.2) mmHg. There was a significant reduction in IOP in week-1 after the first intervention to 24.4 (8.0) mmHg (p = 0.001); however, at 2 weeks the IOP increased to 30.4 (6.7) mmHg. NVI showed significant regression in week-1 after IVB combined with PRP laser (p < 0.05). All eyes required additional glaucoma implants (14 eyes) and cyclocryotheraphy (4 eyes). CONCLUSIONS In the eyes of diabetes patients with NVG, VEGF levels were high. With the use of IVB, the IOP was reduced, and NVI regressed; however, due to the severe stages of disease, all eyes required glaucoma surgery.

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Section: Discussionmentioning

confidence: 99%

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

et al. 2019

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“…[ 3 , 4 , 10 – 31 ] Ahmed glaucoma valve is one of the most commonly used implants and its postoperative success with or without the control of topical antiglaucoma agents was 62.5% to 83.8% at 1 year, 59.3% to 74.7% at 2 years, and 68.5% at 3 years, respectively. [ 10 , 12 , 14 – 16 , 18 , 19 , 23 , 25 , 27 ] The 5-year success rates of Ahmed glaucoma valve implantation were varied, ranging from 20.6% to 70.0%. [ 12 , 26 ] In our study, a significant mean IOP reduction was observed in the first postoperative week, but 3 patients had failed blebs and recurrent NVG afterward.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of neovascular glaucoma with Ex-PRESS glaucoma shunt

Tseng

Chen

et al. 2017

Medicine

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Rationale:Neovascular glaucoma (NVG) is one of the most aggressive types of glaucoma, and its abnormal fibrovascular tissue growth on the iris and trabecular meshwork may create difficulties to control the intraocular pressure (IOP) and perform the operation such as trabeculectomy.Patient concerns:Ex-PRESS glaucoma shunt has been introduced to serve as one alternative operation for glaucoma, and is thought to have the potential advantage of being less traumatic than traditional trabeculectomy. The purpose of our study is to evaluate the efficacy and safety of primary Ex-PRESS implantation in eyes with NVG.Diagnoses and interventions:This was a retrospective study of four patients with NVG in whom primary Ex-PRESS implantation was performed between January 2012 and October 2016.Outcomes:After a mean follow-up of 20.8 ± 8.9 months (range, 15–34 months), three of four NVG patients (75.0%) receiving primary Ex-PRESS implantation had postoperative IOP under 21 mmHg without any antiglaucoma medication control at the last follow-up, but shunt reposition had been performed due to failed blebs or recurrent NVG. Besides, the best corrected visual acuity at the last follow-up was stabilized or improved in three of four NVG patients (75.0%), accompanied with the regression of iris neovascularization. Only one patient had self-resolved postoperative hyphema; otherwise, there were no other perioperative complications.Lessons:Primary Ex-PRESS implantation might constitute a safe and alternative treatment for patients with NVG. In spite of the possible reoperations, the final outcomes were still shown effective after shunt reposition.

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“…We are planning a prospective investigator initiated trial in the future. Furthermore, we cannot try other now available superior anti-VEGF compounds [8] such as aflibercept [19] and devises like the tube surgical option of treatment [24–26] due to disapproval at that time. In addition, as LEC was performed after various treatments, including adequate PRP (100%), anti-VEGF stand-alone therapy (71.9%), and PPV (21.9%), it should be noted that extensive preparation is necessary for the success of LEC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factor Analysis of Intraocular Pressure with Neovascular Glaucoma

Nakano

Nakamuro

Yokoyama

et al. 2016

Journal of Ophthalmology

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Purpose. To perform multivariate analysis for identifying independent predictors of elevated intraocular pressure (IOP) with neovascular glaucoma (NVG), including antivascular endothelial growth factor (VEGF) intravitreal injections. Methods. We retrospectively reviewed 142 NVG patients (181 eyes) with ischemic retinal diseases [proliferative diabetic retinopathy (PDR) in 134 eyes, retinal vein occlusion (RVO) in 29, and ocular ischemic syndrome in 18]. We analyzed age, gender, initial/final LogMAR VA, initial/final IOP, extent of iris and/or angle neovascularization, treatments, preexisting complications, concurrent medications, and follow-up duration. Results. The mean follow-up duration was 23.8 ± 18.8 months. At the final follow-up, 125 (72.3%) eyes had IOP ≤ 21 mmHg. NVG patients with RVO had a higher degree of angle closure and higher IOP. NVG with PDR had better IOP and LogMAR VA. Angle closure had the greatest impact on final IOP. Greater than 90% of patients treated with trabeculectomy with mitomycin C (LEC) had persistent declines in IOP (≤21 mmHg). Stand-alone and combination anti-VEGF therapies were not associated with improved long-term prognosis of IOP. Conclusions. Angle closure was found to have the greatest effect on NVG-IOP prognosis. When target IOP values are not obtained after adequate PRP with or without anti-VEGF, early LEC may improve the prognosis of IOP.

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Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma

Cited by 33 publications

References 20 publications

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

Surgical treatment of neovascular glaucoma with Ex-PRESS glaucoma shunt

Prognostic Factor Analysis of Intraocular Pressure with Neovascular Glaucoma

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