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      Effect of Intravitreal Bevacizumab Injection before Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma

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          Abstract

          Purpose: To assess the efficacy of preoperative intravitreal bevacizumab injection (IVB) before Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG). Methods: This retrospective, comparative and consecutive case series study included 41 eyes from 41 patients who underwent AGV implantation for treatment of NVG. The study group was composed of 19 patients (19 eyes) to whom IVB was administered before surgery, while the control group was composed of 22 patients (22 eyes) to whom IVB was not administered before AGV implantation. Findings such as intraocular pressures measured before and after surgery, surgical success rates, and postoperative complications were compared between the groups. Results: There were no significant differences in preoperative data between groups. The surgical success rate in the study group (79%) was better than in the control group (64%), but this difference was not statistically significant (p = 0.28). Early postoperative complications such as fibrinous reaction in the anterior chamber as well as hyphema were less frequently observed in the study group. Conclusions: Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in eyes with severe NVG and intractable intraocular pressure.

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          Most cited references20

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          Increased level of vascular endothelial growth factor in aqueous humor of patients with neovascular glaucoma.

          This study aimed to quantitate and compare the concentration of vascular endothelial growth factor (VEGF) in aqueous humor samples from patients with neovascular glaucoma (NVG), primary open-angle glaucoma (POAG), and cataract, as well as in serum samples of healthy human subjects. The authors collected aqueous humor samples by using their previously published technique of limbal paracentesis. The authors determined the concentration of VEGF by using a competitive enzyme immunoassay system and four-parameter logistic curve fitting and performed statistical analysis by using the Mann-Whitney-Wilcoxon test. The authors detected VEGF in 12 of 12 samples from patients with NVG (mean +/- standard error of the mean, 29.267 +/- 7.350 ng/ml), 15 of 28 samples from patients with POAG (0.726 +/- 0.204 ng/ml), 4 of 20 aqueous humor samples from patients with cataract (0.257 +/- 0.043 ng/ml), and 16 of 16 human serum samples (20.246 +/- 1.568 ng/ml). The mean concentration of VEGF in aqueous humor of patients with NVG was 40- and 113-fold higher than that in patients with POAG and cataract, respectively, and the difference was statistically significant (P 0.05). The authors' findings show that patients with NVG had a significantly increased level of VEGF in the aqueous humor and implicate VEGF as an important factor in the pathogenesis of intraocular neovascularization in these patients. The authors discuss the possible role of the ciliary epithelium, in addition to retina, in the production of VEGF and the complementary function of basic fibroblast growth factor and other growth factors.
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            Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma.

            To describe a case series of neovascular glaucoma (NVG) caused by central retinal vein occlusion (CRVO) that was treated with intravitreal bevacizumab (IVB; Avastin). Retrospective interventional case series. Six consecutive patients with NVG and a refractory, symptomatic elevation of intraocular pressure (IOP) and pronounced anterior segment congestion received IVB (1.25 mg/0.05 ml). Diode laser cyclophotocoagulation was carried out only if pressure was controlled insufficiently by topical medication. Follow-up examinations occurred at four to 16 weeks. IVB resulted in a marked regression of anterior segment neovascularization and relief of symptoms within 48 hours. IOP decreased substantially in three eyes; in the other three eyes, adjuvant cyclophotocoagulation was necessary. No side effects were observed. Panretinal photocoagulation (PRP) was performed as soon as feasible, five to 12 weeks after IVB treatment. IVB leads to a rapid regression of iris and angle neovascularization and should be investigated more thoroughly as an adjunct in the management of NVG.
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              Evaluation of subconjunctival bevacizumab as an adjunct to trabeculectomy a pilot study.

              To determine whether bevacizumab can reduce bleb failure in patients undergoing first-time trabeculectomy for primary open-angle glaucoma (POAG) or chronic angle-closure glaucoma (CACG). Nonrandomized, open-label, prospective, interventional case series. Twelve individuals (7 males; 5 females) with a diagnosis of POAG or CACG, a recorded intraocular pressure (IOP) of more than 21 mmHg (between 10 am and 12 pm), glaucomatous damage on visual field or optic disc, and taking a maximum tolerated dose of IOP-lowering medication. Unilateral trabeculectomy with subconjunctival injection of bevacizumab (0.05 ml, 1.25 mg) adjacent to the bleb using a 30-gauge needle and tuberculin syringe administered immediately after trabeculectomy. Treatment success (unmedicated IOP of 6 to 16 mmHg inclusive) at 6 months; bleb characteristics according to the Moorfields bleb grading system on days 1, 7, 30, 90, and 180; incidence of postoperative intervention with 5-fluorouracil or mitomycin C; bleb needling; and incidence of and time to surgical failure. Mean age was 54.6+/-13.6 years. The mean preoperative IOP was 24.4+/-7.1 mmHg (range, 12-44 mmHg) and the patients were taking an average of 2.7+/-1.6 IOP-lowering medications (range, 1-4). The mean postoperative IOP was 8+/-3.1 mmHg (range, 4-13 mmHg) on day 1, 9.4+/-2.7 mmHg (range, 6-14 mmHg) on day 7, 10.9+/-2.8 mmHg (range, 8-16 mmHg) at 1 month, 10.3+/-2.5 mmHg (range, 7-14 mmHg) at 3 months, and 11.6+/-2.2 mmHg (range, 8-14 mmHg) at 6 months follow-up with no IOP-lowering medications. Preoperative best-corrected visual acuity was 0.70+/-0.3, whereas at 6 months after trabeculectomy, it was 0.66+/-0.3 (P = 0.39). After a mean follow-up of 182 days, of the 12 eyes, a successful trabeculectomy with respect to IOP control was observed in 11 eyes (92%), with an average IOP reduction of 52%. In this pilot study with a small number of subjects, 6-month outcomes suggest that subconjunctival bevacizumab is a potential adjunctive treatment for reducing the incidence of bleb failure after trabeculectomy. The authors have no proprietary or commercial interest in any materials discussed in this article.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2013
                January 2013
                01 July 2013
                : 229
                : 2
                : 94-100
                Affiliations
                aDepartment of Ophthalmology, Haydarpasa Numune Research and Education Hospital, bDepartment of Ophthalmology, Kartal Lutfi Kirdar Research and Education Hospital, and cDepartment of Ophthalmology, Uskudar State Hospital, Istanbul, Turkey
                Author notes
                *Mehmet Sahin Sevim, MD, Kentplus sitesi, 3. Etap, D6–64 Atasehir, TR–34010 Istanbul (Turkey), E-Mail sahinsevim@hotmail.com
                Article
                345490 Ophthalmologica 2013;229:94–100
                10.1159/000345490
                23364308
                6c23b74e-ceba-44a4-846b-b080a3ac8ea5
                © 2012 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 12 June 2012
                : 24 October 2012
                Page count
                Figures: 2, Tables: 4, Pages: 7
                Categories
                EURETINA – Original Paper

                Vision sciences,Ophthalmology & Optometry,Pathology
                Intravitreal bevacizumab,Neovascular glaucoma,Ahmed glaucoma valve

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