Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy

Shen, Xi; Chen, Yanwei; Wang, Yanuo; Lu, Yang; Zhong, Yisheng

doi:10.1155/2016/4108490

Cited by 8 publications

(11 citation statements)

References 24 publications

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“…[ 2 , 54 , 57 ] In addition, after using anti-VEGF agents as an adjuvant therapy with glaucoma surgery, the results have been better than previous treatments. [ 58 – 60 ] There have even been studies reporting NVG regression after treatment with anti-VEGF agents, with or without PRP. [ 61 – 63 ]…”

Section: Discussionmentioning

confidence: 99%

Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy

Kwon

Jee²,

La³

2017

Medicine

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To evaluate the prevalence and risk factors of neovascular glaucoma (NVG) after vitrectomy in patients with vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR). This retrospective, noncomparative, observational study included 127 eyes of 127 patients with PDR who received vitrectomy with a follow-up period of at least 6 months. The prevalence of NVG and associated risk factors were assessed including sex, age, previous panretinal photocoagulation, baseline intraocular pressure, combined phacovitrectomy, and pretreatment with intravitreal bevacizumab (IVB) before vitrectomy for the treatment of vitreous hemorrhage. NVG developed in 15 (11.8%) of 127 patients. Of the 15 eyes with NVG, 11 cases (73.3%) postoperatively developed NVG within 6 months. Postoperative NVG was associated with preoperative IVB treatment (odds ratio, 4.43; P = 0.019). The prevalence of NVG after vitrectomy was 11.8%, and an associated risk factor for NVG was preoperative IVB for the treatment of vitreous hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy

Kwon

Jee²,

La³

2017

Medicine

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“…Previous data reporting practical experience with anti-VEGF agents, as well as general considerations about the disease, suggest that an early endpoint is appropriate to detect whether the treatment with anti-VEGF is able to provide earlier control of the disease manifestations than standard treatment options. The evaluation timing for the primary endpoint was therefore determined to be at week 1 [7][8][9]. Limitations of this study include that, for ethical reasons, treatment with systemic IOPlowering treatments was permitted throughout the study, because elevated IOP can quickly lead to irreversible loss of vision [2].…”

Section: Discussionmentioning

confidence: 99%

“…Retinal ischemia, thought to be the mediator in the majority of NVG cases [4], results in the release of angiogenic factors, such as vascular endothelial growth factor (VEGF), which trigger neovascularization [2]. It has been suggested that anti-VEGF treatments have a positive influence on outcomes in patients with NVG [7][8][9]. The results of the VEGA and VENERA studies supported the approval of intravitreal aflibercept (IVT-AFL) injection (2 mg) in 2020 as a treatment for patients with NVG in Japan [10].…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Aflibercept in Japanese Patients with Neovascular Glaucoma: The VEGA Randomized Clinical Trial

et al. 2020

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Introduction Neovascular glaucoma is characterized by neovascularization of the iris and the anterior angle chamber. Intravitreal anti-vascular endothelial growth factor agents may improve intraocular pressure (IOP) and neovascularization. Methods The VEGA trial assessed the efficacy and safety of intravitreal aflibercept (IVT-AFL) in patients with neovascular glaucoma in a 13-week, randomized, double-masked, sham-controlled, phase 3 study performed at multiple sites in Japan that enrolled patients with anterior segment neovascularization and IOP > 25 mmHg. Patients received background therapy plus IVT-AFL (2 mg) or sham injection at baseline. Patients were re-treated if presenting with IOP > 21 mmHg and incomplete regression of iris neovascularization, receiving additional sham or IVT-AFL injections at week 1 and IVT-AFL injections at weeks 5 and/or 9. Double-masking was maintained throughout. The primary endpoint was change in IOP from baseline to week 1. Results Fifty-four patients were randomly assigned (full analysis set); the per-protocol set comprised 52 patients. At week 1, the least squares mean change in IOP was −9.9 mmHg for IVT-AFL versus −5.0 mmHg for sham [full analysis set: difference −4.9 mmHg (95% confidence interval −10.2 to 0.3; P = 0.06); per-protocol set: −5.5 mmHg (95% CI −10.8 to −0.2; P = 0.04)]. At week 1, a greater proportion of patients administered IVT-AFL versus sham achieved IOP ≤ 21 mmHg and had improved neovascularization grades. Patients in the sham group who met re-treatment criteria and received IVT-AFL at week 1 [ n = 22 (81.5%)] had an additional mean IOP decrease of 9.2 mmHg by week 2, and the proportion with improvement in neovascularization grades increased from 11.5% to 69.2%. Increases in the proportion of patients with improved neovascularization grades and the proportion who achieved IOP control (≤ 21 mmHg) were also observed by week 2 in this group. Overall, 77.8% and 74.1% of patients treated with IVT-AFL and sham/IVT-AFL, respectively, received a single IVT-AFL injection. The most common ocular treatment-emergent adverse event was punctate keratitis (9.3%: 7.4% and 11.1% in the IVT-AFL and sham/IVT-AFL groups, respectively). Conclusions IVT-AFL was associated with clinically meaningful improvements in IOP control, indicating that IVT-AFL may be a potential treatment option for patients with neovascular glaucoma. Trial Registration Clinicaltrials.gov identifier, NCT02396316. Electronic supplementary material The online version of this article (10.1007/s12325-020-01579-5) contains supplementary material, which is available to authorized users.

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“…Research has shown contradictory results regarding the intravitreal use of anti-VEGF drugs with the goal of preventing NVG. A number of researchers believe that intravitreal use of anti-VEGF may improve clinical manifestation of NVG and that treatment with these drugs could be very useful [ 21 ]. There have been published controversial studies in which other researchers disagree with the aforementioned view, believing that the anti-VEGF application itself, and especially its longer use, can lead to an increase in IOP, thus increasing the risk of glaucoma occurrence and progression [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Vitreous concentrations of vascular endothelial growth factor as a potential biomarker for postoperative complications following pars plana vitrectomy

Nišić¹,

Jovanović²,

Mavija³

et al. 2019

aoms

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A b s t r a c tIntroduction: The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) concentration in vitreous on postoperative complications after pars plana vitrectomy (PPV). Material and methods: Ninety subjects were surgically treated with PPV and followed up for 12 months at the Clinical Centre University Sarajevo, Clinic for Eye Disease. Exclusion criteria were presence of other eye diseases, systemic acute/chronic inflammatory conditions, or malignant neoplasms; previously performed PPV surgery; previously received intravitreal or systemic anti-VEGF therapy. A vitreous sample was obtained while performing the PPV procedure, using the Quantikine ELISA test to determine VEGF level, as a risk factor. Outcome measures were intraoperative and postoperative complications reported using categorical data: blunt and sharp dissection of membranes, intraoperative hemorrhage stopped by increasing infusion pressure, pressing with blunt instrument, or using diathermy. The following postoperative complications were assessed on the first day and at the 12-month follow-up visit: vitreous hemorrhage, fibrovascular proliferation (FVP), rubeosis iridis, and neovascular glaucoma (NVG). Results: Levels of vitreous VEGF at the time of PPV were significantly higher in eyes with: vitreous hemorrhage on the first day after PPV (p = 0.003); FVP on the first day and 12 months after PPV (p = 0.002 and p < 0.001, respectively); iris rubeosis on the first day and 12 months after PPV surgery (p < 0.001, and p = 0.001, respectively); NVG on the first day and 12 months after PPV surgery (p = 0.043 and p = 0.011, respectively), compared to the eyes without complications. Conclusions: Preoperative levels of VEGF in vitreous can be a useful biomarker and predictor of the postoperative outcome in terms of intraoperative and postoperative complications.

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Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy

Cited by 8 publications

References 24 publications

Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy

Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy

Intravitreal Aflibercept in Japanese Patients with Neovascular Glaucoma: The VEGA Randomized Clinical Trial

Vitreous concentrations of vascular endothelial growth factor as a potential biomarker for postoperative complications following pars plana vitrectomy

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