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Outcome of Intravitreal Bevacizumab (Avastin) Followed by Aqueous
Shunting Tube Surgery for Management of Intractable Neovascular
Glaucoma
Tarek M. Eid
Ophthalmology Dept., Faculty of Medicine, Tanta University, Egypt.
Cataract and Glaucoma Unit, Magrabi Eye & Ear Center, Jeddah, Saudi
Arabia
Tanta Med. Sc. J 2008; 3(2):47-54
Article type: Original article
Aim: To study safety and efficacy of intravitreal Bevacizumab (IVB)
injection followed by aqueous shunting tube surgery (ASTS) for
management of neovascular glaucoma (NVG) with intractable high IOP.
Patients and Methods: Twenty-five eyes of 25 patients with NVG and
high IOP not responsive to maximally tolerated antiglaucoma
medications were treated with ASTS (Ahmad valve). Patients were
classified into two groups; Group 1 (14 eyes) received IVB (1.25 mg/
0.05ml) before ASTS. These eyes had severe retinopathy, florid NVI,
dense cataract, or corneal edema that prevented proper panretinal
photocoagulation (PRP) before glaucoma surgery. Group 2 (11 eyes)
was treated by PRP followed by ASTS without IVB injection. Outcome
measures included IOP reduction and operative complications.
Results: Mean preoperative IOP was 56.3 mmHg in group 1 and 53.3
mmHg in group 2 (p=0.8). After IVB injection, NVI regressed markedly
with media clarity and mild reduction of IOP (44.2 mmHg). Average
duration between IVB injection and ASTS was 12 days. IOP at last
follow-up was 19.5 mmHg in group 1 and 17.6 mmHg in group 2 (p=0.5),
with 5 eyes in group 1 and 4 eyes in group 2 on antiglaucoma drops.
Post-ASTS complications were comparable between both groups. One eye
in each group had one surgical intervention to treat postoperative
complications. One eye in group 2 required additional glaucoma
surgery. Conclusion: Intravitreal Bevacizumab is a useful
preparatory step to safely and effectively implant an aqueous
shunting tube in eyes with severe NVG and intractable IOP which
cannot be treated preoperatively by PRP. |