Effect of Preoperative Intravitreal Bevacizumab on the Surgical Outcome of Neovascular Glaucoma at Different Stages.

Junki Kwon,Kyung Rim Sung

doi:10.1155/2017/7672485

Junki Kwon, Kyung Rim Sung

Open Access

https://doi.org/10.1155/2017/7672485

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Abstract

Purpose To evaluate the effect of preoperative intravitreal bevacizumab (IVB) injection on the surgical outcome of Ahmed glaucoma valve (AGV) implantation according to the angle status in neovascular glaucoma (NVG) eyes. Materials and Methods This retrospective study included 70 NVG patients who underwent AGV implantation and were followed up for at least 12 months. An IVB injection before AGV implantation was administered to 45 eyes (IVB group), while it was not administered to 25 eyes (control group). Subgroup analyses were done at different stages in terms of the extent of peripheral anterior synechiae (PAS). Results Mean follow-up period after AGV implantation was 27 ± 15 months. The IVB group showed higher prevalence of the eyes with less than 50% of PAS than that of the control group (78% versus 44%). The overall success rate 1 year postoperatively was 80% and 64% for the IVB and control groups, respectively (P = 0.142). When PAS extent was less than 50%, preoperative IVB had a marginally positive effect on surgical outcome (HR = 0.39, P = 0.064, per 1-time IVB injection). Conclusions Preoperative IVB may enhance the success rate of AGV implantation in NVG eyes, before PAS has extensively formed. Further prospective randomized studies controlling the extent of PAS are warranted.

Highlights

Neovascular glaucoma (NVG) is still a medical and surgical challenge for ophthalmologists
A total of 70 patients met the inclusion criteria and included in the final analysis, of which a preoperative intravitreal bevacizumab (IVB) injection was administered to 45 eyes (IVB group) and was not administered to 25 eyes
There was no significant difference in age, gender, cause of NVG, baseline intraocular pressure (IOP), BCVA, and followup period between the two groups

Summary

Introduction

Neovascular glaucoma (NVG) is still a medical and surgical challenge for ophthalmologists. Adjuvant IVB injection may lead to regression of NV in the iris and angle, reducing the incidence of hyphema and potentially enhancing the surgical outcome of Ahmed glaucoma valve (AGV) implantation in NVG [10, 12]. The effect of IVB on medical treatment of NVG at different stages was previously reported in 2008 [15]. We compared the surgical outcomes of the eyes of patients with NVG, in terms of IOP between those who received a preoperative IVB injection with AGV implantation (IVB group) and those who underwent AGV implantation alone (control group). We performed subgroup analysis based on the anterior chamber angle status (i.e., the extent of PAS) to assess the adjuvant effect of preoperative IVB on the outcome of AGV implantation at different stages of NVG

Materials and Methods

Results

Discussion