Long-Term Outcomes and Prognostic Factors of Trabeculectomy following Intraocular Bevacizumab Injection for Neovascular Glaucoma

Abstract

PurposeTo evaluate long-term outcomes and identify prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma.MethodsSixty-one eyes of 54 patients with neovascular glaucoma treated by trabeculectomy following intraocular bevacizumab injection were consecutively enrolled. Surgical success criteria were sufficient intraocular pressure (IOP) reduction (IOP ≤21 mmHg, ≥20% IOP reduction, no additional medications or glaucoma surgeries) without devastating complications (loss of light perception, phthisis bulbi, and endophthalmitis) or significant hypotony (IOP ≤5 mmHg continued ≥6 months and until the last follow-up visit or hypotony requiring intervention). Kaplan-Meier survival curves and Cox regression analysis were used to examine success rates and risk factors for surgical outcomes.ResultsThe follow-up period after trabeculectomy was 45.0 ± 22.2 months (mean ± standard deviation). Surgical success rate was 86.9 ± 4.3% (± standard error), 74.0 ± 6.1%, and 51.3 ± 8.6% at 1, 3, and 5 years. Multivariate Cox regression analysis identified two risk factors; lower preoperative IOP (≤30 mmHg) for surgical failure and hypotony [hazard ratio (HR), 2.92, 6.64; 95% confidence interval (CI), 1.22 to 7.03, 1.47 to 30.0; P = 0.018, 0.014, respectively], and vitrectomy after trabeculectomy for surgical failure with or without hypotony criteria (HR, 2.32, 4.06; 95% CI, 1.02 to 5.28, 1.30 to 12.7; P = 0.045, 0.016, respectively).ConclusionsThe long-term outcomes of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma were favorable. Lower baseline IOP was associated with development of significant hypotony, while additional vitrectomy was related to insufficient IOP reduction.

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

“…Similar results have also been demonstrated in other studies showing unchanged final VA in patients with initial poor VA (counting fingers and light perception). 17,19 In contrast, another study reported better results in eyes with early NVI. 15,20 From this study, on management patient with DM and NVG eyes in the Indonesian population: the first step in the controlling of NVG is to reduce IOP as quickly as possible in order to minimize optic nerve damage caused by a high IOP.…”

“…Damage to these vessels can lead to intraoperative bleeding. 7,13,19 Therefore, the use of fast-acting anti-VEGF agents is rationalized prior to such surgery in order to reduce and induce anterior segment neovascularization regression. 20,21 Anti-VEGF induce regression of neovascularization in PDR and also facilitate rapid regression of anterior segment neovascularization.…”

“…20,21 Anti-VEGF induce regression of neovascularization in PDR and also facilitate rapid regression of anterior segment neovascularization. 13,14,[17][18][19][20][21][22][23] Several studies have reported promising results from the use of IVB injection to reduce NVI and the anterior chamber angle within a short period (2-4 days). 7,15 This study showed that regression of NVI occurred in most subjects within a week following IVB injection combined with PRP laser.…”

“…If the trabecular meshwork is still visible and healthy, IVB injection will be sufficient to prevent development of primary angle closure. [19][20][21][22] In the early stages of NVG pathology, the angle chamber is still open; however, if not handled in the correct way, the anterior chamber angle will close due to neovascularization, connective tissue membrane and fibrosis. This mechanism occurs along with increasing high cytokines to induce an inflammatory reaction and will cause damage to the trabecular meshwork structures.⁵…”

Role of Platelet Parameters on Neovascular Glaucoma: A Retrospective Case-Control Study in China

“…The definition of NVG was: (1) IOP>21 mmHg; (2) caused by retinal vascular disease (RVO or DR); (3) the presence of active neovascularization in the iris and/or angle; (4) with or without antiglaucomatous medications. [23] Newly diagnosed NVG patients and referral NVG patients were also included. Each patient underwent a standardized ophthalmic examination, which included refractive status, slit-lamp biomicroscopy, fundus examination, IOP (intraocular pressure), CCT (central corneal thickness), AL (axial length), ACD (anterior chamber depth), visual field examination, and gonioscopy, performed by glaucoma specialists.…”