Management of Neovascular Glaucoma With Panretinal Photocoagulation, Intravitreal Bevacizumab, and Subsequent Trabeculectomy With Mitomycin C

Alkawas, Ayman Ahmed; Shahien, Ezzat A.; Hussein, Atef

doi:10.1097/ijg.0b013e3181ccb794

Cited by 40 publications

(40 citation statements)

References 29 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: 95%

“…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: 95%

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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“…Bevacizumab often promotes regression of anterior segment NV but its effect is usually temporary and panretinal photocoagulation remains Mean IOP was reduced from 42.9 to 19.7 mmHg at 6 months, complete regression of the iris NV was achieved in 14 cases and hypotony occurred in only 3 [100].…”

Section: Othermentioning

confidence: 95%

Review of the latest treatments for retinal vein occlusions: emphasis on pharmacologic therapy

Stewart

2014

Expert Review of Ophthalmology

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Retinal vein occlusions (central and branch) are the second most common retinal vascular disorders. Affected patients lose vision due to retinal non-perfusion, vitreous hemorrhage, traction retinal detachments and neovascular glaucoma, but the most common cause of vision loss is macular edema. Animal models and human studies show that breakdown of the blood-retinal barrier results from overexpression of various cytokines and chemokines with upregulation of VEGF being critically important. Laser photocoagulation decreases macular edema due to branch retinal vein occlusion and reduces the overall ischemic drive but resultant improvements in visual acuity are modest (1.5 lines vs 0.3 lines with observation). Laser decreases macular edema in central retinal vein occlusion but does not improve visual acuity better than observation. Numerous surgical treatments have been proposed but none are of proven benefit. Monthly intravitreal injections of drugs that bind diffusible VEGF improve visual acuity and decreases macular edema in most patients. After an initial regimen of intensive monthly therapy, the treatment burden appears to decrease and many patients are ultimately able to discontinue therapy. Corticosteroids (triamcinolone and the dexamethasone delivery system) also restore the blood-retinal barrier but due to high incidences of cataracts and glaucoma, they are generally used as second-line therapy. Ongoing trials are focusing on combination therapy (anti-VEGF, corticosteroids and laser photocoagulation) to optimize visual recovery and decrease treatment burden.KEYWORDS: aflibercept • bevacizumab • dexamethasone delivery system • laser photocoagulation • macular edema • pegaptanib • ranibizumab • triamcinolone • VEGF • vitrectomyRetinal vein occlusion (RVO) due to an obstruction in venous outflow results in increased venous pressure, prolonged vascular transit time, retinal ischemia and breakdown of the blood-retinal barrier (BRB). The unmistakable fundus appearance includes dilated, tortuous retinal veins, a hemorrhagic 'blood and thunder' retina (FIGURE 1), disc swelling and macular edema. The severity of vision loss usually depends upon the amount of macular edema and retinal ischemia with severely affected patients experiencing a poorer quality of life [1].RVO is the second most common retinal vascular condition (after diabetic retinopathy) with a 15-year cumulative incidence of 2.3% [2,3]. Each year RVOs strike 180,000 Americans and 300,000 people in the EU with 80% of these being branch retinal vein occlusions (BRVOs) [3,4] and the balance are central retinal vein occlusions (CRVOs) [3,5]. Of those patients diagnosed with a CRVO, 1.4% develop a CRVO in the fellow eye within 3 years [6], 5% develop a BRVO in the other eye within 30 months [7] and 5% will develop any additional RVO within 1 year [8]. Five to six percent of affected patients have bilateral RVOs at baseline and 10% of the balance eventually develop a second occlusion [9].In most BRVOs, the obstructions are found at arteriovenous crossing sites ...

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“…As PRP requires several weeks to exert its effects, it is ideally performed urgently (2 or 3 weeks prior to surgery) to reduce the risk of hyphema and bleb failure, assuming adequate corneal clarity [10]. Furthermore, PRP itself can lead to increased IOP from cilio-choroidal effusions, necessitating close follow-up [11].…”

Section: Panretinal Photocoagulation (Prp)mentioning

confidence: 99%

A paradigm shift in the management of neovascular glaucoma

Jeganathan¹,

Wardrop²

2016

New Front Ophthalmol

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Neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) is a potentially devastating condition. The commonest cause of treatment failure in NVG is underlying systemic disease progression. The underlying ischemia is often refractory to medical treatment. Surgical options have evolved to include Bevacizumab in the Ophthalmologist's armamentarium. Visual prognosis can be guarded in these patients who additionally have reduced life expectancy. Thus, early diagnosis and aggressive treatment is imperative to avert visual loss, and improve their prognosis. We present a case of NVG secondary to PDR which was challenging to treat. The patient adherent to his treatment plan and achieved unusually successful results, maintaining good vision.

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Management of Neovascular Glaucoma With Panretinal Photocoagulation, Intravitreal Bevacizumab, and Subsequent Trabeculectomy With Mitomycin C

Abstract: Trabeculectomy with intraoperative mitomycin C after an adjunctive treatment with intravitreal bevacizumab and panretinal photocoagulation is a good treatment modality in the management of eyes with neovascular glaucoma.

Cited by 40 publications

References 29 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

Review of the latest treatments for retinal vein occlusions: emphasis on pharmacologic therapy

A paradigm shift in the management of neovascular glaucoma

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