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Şahin V, Ayaz Y, Yücel I, Şen EBT. Long-term results of Ahmed glaucoma valve implantation with/without intravitreal anti-VEGF injection in neovascular glaucoma patients. J Fr Ophtalmol 2024; 47:104240. [PMID: 38959587 DOI: 10.1016/j.jfo.2024.104240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation with or without anti-VEGF injections in neovascular glaucoma patients. MATERIALS AND METHODS This single-center retrospective study assessed NVG patients who underwent AGV implantation with or without anti-VEGF injections. Demographic and clinical data, including ocular findings, intraocular pressure (IOP), visual acuity, and glaucoma medication count, were recorded preoperatively and postoperatively at one day, one month, and one year. The study included 35 patients. Group 1 consisted of 23 patients who received anti-VEGF injections before AGV surgery. Group 2, with 12 patients, had no anti-VEGF injections prior to surgery. Successful surgery was defined as IOP values between 6 and 21mmHg. The primary outcome was a 30% or more reduction in IOP. RESULTS The groups displayed no significant difference in their demographic or clinical profiles (P>0.05). The visual acuity before and one year after surgery did not differ significantly between the groups. However, IOP values significantly decreased by the end of the one-year follow-up for both groups. No significant differences were found between the groups regarding visual acuity, IOP, or the number of medications during the one-year follow-up (P>0.05). Success rates were 95.7% for Group 1 and 91.7% for Group 2. No significant difference in complications between the groups was observed (P>0.05). CONCLUSION Anti-VEGF injections prior to AGV implantation did not significantly impact visual acuity, IOP values, or medication count during the one-year follow-up.
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Affiliation(s)
- V Şahin
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, Konyaaltı Cad. No:22, 07070 Kepez/Antalya, Turkey.
| | - Y Ayaz
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, Konyaaltı Cad. No:22, 07070 Kepez/Antalya, Turkey
| | - I Yücel
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, Konyaaltı Cad. No:22, 07070 Kepez/Antalya, Turkey
| | - E B T Şen
- Department of Ophthalmology, Faculty of Medicine, Akdeniz University, Konyaaltı Cad. No:22, 07070 Kepez/Antalya, Turkey
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Zhou X, Chen J, Luo W, Du Y. Short-Term Outcomes of Trabeculectomy With or Without Anti-VEGF in Patients With Neovascular Glaucoma: A Systematic Review and Meta-Analysis. Transl Vis Sci Technol 2023; 12:12. [PMID: 37728893 PMCID: PMC10516766 DOI: 10.1167/tvst.12.9.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives The aim of this study was to compare the safety and efficacy of trabeculectomy alone or combined with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents for the treatment of neovascular glaucoma. Methods We conducted a systematic review and meta-analysis to compare the effects of trabeculectomy alone or combined with intravitreal injections of anti-VEGF agents for the treatment of neovascular glaucoma. We searched four databases (PubMed, Cochrane Library, Embase, and Web of Science) up to January 2023 and extracted data on three surgical outcomes: postoperative intraocular pressure, success rate and complications. We used a random-effects model to calculate pooled relative risk (RR) or standardized mean difference (SMD) estimates and 95% confidence intervals (CIs). We assessed publication bias using Begg and Egger tests. Results We included seven studies with 353 eyes. Compared to trabeculectomy alone, trabeculectomy with anti-VEGF had a lower risk of postoperative complications (RR, 0.60; 95% CI, 0.41-0.89) and higher success rate (RR, 1.19; 95% CI, 1.02-1.40). The intraocular pressure reduction was significantly greater in the trabeculectomy with anti-VEGF augmentation group than the trabeculectomy group from 1 week (SMD, -1.36; 95% CI, -2.76 to 0.04) to 6 months (SMD, -0.79; 95% CI, -1.50 to -0.07) after surgery. Conclusions According to current evidence, adding intravitreal injection of anti-VEGF agents to trabeculectomy may improve the short time outcomes of patients with neovascular glaucoma.
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Affiliation(s)
- Xi Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jun Chen
- Department of Ophthalmology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping, Fujian, China
| | - Wenjing Luo
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Azhany Y, Rahman WFWA, Jaafar H, Low JH, Yusuf WNW, Liza-Sharmini AT, Che Hamzah J. Clinical and Histopathological Effects of Intracameral Ranibizumab in Experimental Trabeculectomy. Int J Mol Sci 2023; 24:7372. [PMID: 37108535 PMCID: PMC10138567 DOI: 10.3390/ijms24087372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Post-surgical scarring is a known cause of trabeculectomy failure. The aim of this study was to investigate the effectiveness of ranibizumab as an adjuvant anti-scarring agent in experimental trabeculectomy. Forty New Zealand white rabbits were randomised into four eye treatment groups: groups A (control), B (ranibizumab 0.5 mg/mL), C (mitomycin C [MMC] 0.4 mg/mL), and D (ranibizumab 0.5 mg/mL and MMC 0.4 mg/mL). Modified trabeculectomy was performed. Clinical parameters were assessed on post-operative days 1, 2, 3, 7, 14, and 21. Twenty rabbits were euthanised on day 7, and the other twenty were euthanised on day 21. Eye tissue samples were obtained from the rabbits and stained with haematoxylin and eosin (H&E). All treatment groups showed a significant difference in IOP reduction compared with group A (p < 0.05). Groups C and D showed a significant difference in bleb status on days 7 (p = 0.001) and 21 (p = 0.002) relative to group A. H&E staining showed significantly low fibrotic activity (p < 0.001) in group C on both days and inflammatory cell grade in group B on day 7 (p < 0.001). The grade for new vessel formation was significantly low in groups B and D on day 7 (p < 0.001) and in group D on day 21 (p = 0.007). Ranibizumab plays a role in reducing scarring, and a single application of the ranibizumab-MMC combination showed a moderate wound-modulating effect in the early post-operative phase.
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Affiliation(s)
- Yaakub Azhany
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Wilayah Persekutuan, Malaysia
- Department of Ophthalmology & Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Wan Faiziah Wan Abdul Rahman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Hasnan Jaafar
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Jen Hou Low
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Wan Nazirah Wan Yusuf
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ahmad-Tajudin Liza-Sharmini
- Department of Ophthalmology & Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Jemaima Che Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Wilayah Persekutuan, Malaysia
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Urbonavičiūtė D, Buteikienė D, Janulevičienė I. A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121870. [PMID: 36557072 PMCID: PMC9787124 DOI: 10.3390/medicina58121870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.
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Affiliation(s)
- Danielė Urbonavičiūtė
- Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania
- Correspondence: ; Tel.: +370-6112-7522
| | - Dovilė Buteikienė
- Department of Ophthalmology, Medical Academy, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| | - Ingrida Janulevičienė
- Department of Ophthalmology, Medical Academy, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
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Kaushik J, Parihar JKS, Shetty R, Singh A, Chaturvedi P. A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma. J Curr Glaucoma Pract 2022; 16:41-46. [PMID: 36060043 PMCID: PMC9385393 DOI: 10.5005/jp-journals-10078-1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion How to cite this article
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Affiliation(s)
- Jaya Kaushik
- Department of Ophthalmology, Armed Forces Medical College Pune, Maharashtra, India
- Jaya Kaushik, Department of Ophthalmology, Armed Forces Medical College Pune, Maharashtra, India, Phone: +91 8390010094, e-mail:
| | | | - Rakesh Shetty
- Department of Ophthalmology, Armed Forces Medical College Pune, Maharashtra, India
| | - Ankita Singh
- Department of Ophthalmology, Armed Forces Medical College Pune, Maharashtra, India
| | - Piyush Chaturvedi
- Department of Ophthalmology, Command Hospital, Panchkula, Haryana, India
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Inatani M, Higashide T, Matsushita K, Miki A, Ueki M, Iwamoto Y, Kobayashi M, Leal S. Intravitreal Aflibercept in Japanese Patients with Neovascular Glaucoma: The VEGA Randomized Clinical Trial. Adv Ther 2021; 38:1116-1129. [PMID: 33330958 PMCID: PMC7889669 DOI: 10.1007/s12325-020-01579-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
Introduction Neovascular glaucoma is characterized by neovascularization of the iris and the anterior angle chamber. Intravitreal anti-vascular endothelial growth factor agents may improve intraocular pressure (IOP) and neovascularization. Methods The VEGA trial assessed the efficacy and safety of intravitreal aflibercept (IVT-AFL) in patients with neovascular glaucoma in a 13-week, randomized, double-masked, sham-controlled, phase 3 study performed at multiple sites in Japan that enrolled patients with anterior segment neovascularization and IOP > 25 mmHg. Patients received background therapy plus IVT-AFL (2 mg) or sham injection at baseline. Patients were re-treated if presenting with IOP > 21 mmHg and incomplete regression of iris neovascularization, receiving additional sham or IVT-AFL injections at week 1 and IVT-AFL injections at weeks 5 and/or 9. Double-masking was maintained throughout. The primary endpoint was change in IOP from baseline to week 1. Results Fifty-four patients were randomly assigned (full analysis set); the per-protocol set comprised 52 patients. At week 1, the least squares mean change in IOP was −9.9 mmHg for IVT-AFL versus −5.0 mmHg for sham [full analysis set: difference −4.9 mmHg (95% confidence interval −10.2 to 0.3; P = 0.06); per-protocol set: −5.5 mmHg (95% CI −10.8 to −0.2; P = 0.04)]. At week 1, a greater proportion of patients administered IVT-AFL versus sham achieved IOP ≤ 21 mmHg and had improved neovascularization grades. Patients in the sham group who met re-treatment criteria and received IVT-AFL at week 1 [n = 22 (81.5%)] had an additional mean IOP decrease of 9.2 mmHg by week 2, and the proportion with improvement in neovascularization grades increased from 11.5% to 69.2%. Increases in the proportion of patients with improved neovascularization grades and the proportion who achieved IOP control (≤ 21 mmHg) were also observed by week 2 in this group. Overall, 77.8% and 74.1% of patients treated with IVT-AFL and sham/IVT-AFL, respectively, received a single IVT-AFL injection. The most common ocular treatment-emergent adverse event was punctate keratitis (9.3%: 7.4% and 11.1% in the IVT-AFL and sham/IVT-AFL groups, respectively). Conclusions IVT-AFL was associated with clinically meaningful improvements in IOP control, indicating that IVT-AFL may be a potential treatment option for patients with neovascular glaucoma. Trial Registration Clinicaltrials.gov identifier, NCT02396316. Electronic supplementary material The online version of this article (10.1007/s12325-020-01579-5) contains supplementary material, which is available to authorized users.
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Efficacy and Safety of Intravitreal Aflibercept Injection in Japanese Patients with Neovascular Glaucoma: Outcomes from the VENERA Study. Adv Ther 2021; 38:1106-1115. [PMID: 33330959 PMCID: PMC7889553 DOI: 10.1007/s12325-020-01580-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022]
Abstract
Introduction Neovascular glaucoma is characterized by neovascularization of the iris and anterior angle chamber. Intravitreal anti-vascular endothelial growth factor agents may decrease intraocular pressure (IOP) and improve neovascularization. The VENERA study assessed the efficacy and safety of intravitreal aflibercept (IVT-AFL) in patients with neovascular glaucoma. Methods This was a 5-week, single-arm, nonrandomized, open-label, phase 3 study performed at 7 study sites in Japan that enrolled Japanese patients with anterior segment neovascularization and IOP > 25 mmHg who had not undergone (within 30 days prior), nor were imminently scheduled to undergo (within 8 days following) intraocular surgeries, including panretinal photocoagulation (PRP). Patients received background therapy plus 2 mg IVT-AFL at baseline. Background therapy with systemic IOP-lowering drugs was prohibited for 3 days before day 1 and until IOP evaluation at week 1. The primary endpoint was the change in IOP from baseline to week 1 and the secondary endpoint was the proportion of patients with an improvement of ≥ 1 grade of neovascularization of the angle (NVA) from baseline to week 1. Results Sixteen patients received treatment (full analysis set); the per-protocol set comprised 15 patients. The mean IOP decreased from 34.1 mmHg at baseline to 25.8 mmHg at week 1 (mean change, −8.3 mmHg [95% confidence interval; CI −12.2 to −4.4; P = 0.0004]). At week 1, 81.3% of patients had an improvement in the grade of neovascularization of the iris (NVI) and 50.0% of patients had an improvement in NVA grade. The proportion of patients with controlled IOP (≤ 21 mmHg) was 43.8% (95% CI 19.8–70.1) at week 1, and increased to 56.3% at week 2 and 86.7% at week 5. The most common ocular treatment-emergent adverse event was eye pain, which occurred in 4 patients (25.0%). Conclusions IVT-AFL was associated with statistically significant and clinically meaningful IOP reductions, without concomitant use of systemic IOP-lowering drugs or PRP. The safety profile was consistent with the known safety profile of IVT-AFL. These findings supplement those from the previous VEGA study, and suggest that IVT-AFL may be a potential treatment option for patients with neovascular glaucoma. Trial Registration Clinicaltrials.gov identifier NCT03639675. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01580-y.
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Strzalkowski P, Strzalkowska A, Göbel W, Loewen NA, Hillenkamp J. Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma - a retrospective interventional case series. F1000Res 2020; 9:1236. [PMID: 33796275 PMCID: PMC7970436 DOI: 10.12688/f1000research.26879.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.
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Affiliation(s)
- Piotr Strzalkowski
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Alicja Strzalkowska
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Winfried Göbel
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Nils A. Loewen
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
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Strzalkowski P, Strzalkowska A, Göbel W, Loewen NA, Hillenkamp J. Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma - a retrospective interventional case series. F1000Res 2020; 9:1236. [PMID: 33796275 PMCID: PMC7970436 DOI: 10.12688/f1000research.26879.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 04/01/2024] Open
Abstract
Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.
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Affiliation(s)
- Piotr Strzalkowski
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Alicja Strzalkowska
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Winfried Göbel
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Nils A. Loewen
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, School of Medicine, University Hospital Wuerzburg, 97080, Germany
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Abstract
Neovascular glaucoma (NVG) is the most frequently occurring type of secondary glaucoma characterized by significant decrease in visual functions. Its pathogenesis consists mainly of ischemia of the posterior segment, which is often secondary to proliferative diabetic retinopathy or ischemic central retinal vein occlusion. Development of neovascularization in the eye is associated with processes that change homeostatic balance between proangiogenic (vascular endothelial growth factor (VEGF)) and antiangiogenic (pigment epithelium-derived factor (PEDF)) factors. The aim of the therapy is to reduce the production of aqueous humour. Application of antiangiogenic preparations in patients with NVG as adjuvant therapy is the method of choice for both prevention and treatment of the disease. The article reviews literature on current possibilities of using anti-VEGF drugs in the treatment of NVG.
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Affiliation(s)
- M A Karpilova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - M H Durzhinskaya
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Sánchez-Tabernero S, Juberías JR, Artells N, Crespo-Millas S, Meneses C, Muñoz-Moreno MF, Manzanas L, López Gálvez MI. Management and Systemic Implications of Diabetic Neovascular Glaucoma. Ophthalmic Res 2019; 62:111-115. [PMID: 31167215 DOI: 10.1159/000500607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study the efficacy and safety of different treatments for diabetic neovascular glaucoma (NVG). We additionally attempt to determine if the presence of NVG could be a predictor of cardiovascular disease or death. METHOD This is a retrospective, observational cohort study including patients diagnosed with diabetic NVG from 2006 to 2016 at the Hospital Clínico Universitario de Valladolid (Spain). Extracted data included clinical characteristics of the patients, glycated haemoglobin levels, and ocular treatment. Visual acuity (VA), intraocular pressure (IOP), cardiovascular events, and deaths were registered. RESULTS 30 eyes from 23 patients were followed for a mean of 4.48 years (SD = 2.82 years). The IOP-lowering intervention groups were: Ahmed implant (11 eyes), laser cyclo-photocoagulation (CPC; 6 eyes), both (4 eyes), or none (9 eyes). IOP success was achieved in 100% of the eyes with Ahmed and/or laser CPC and in 44.4% of the eyes with no IOP-lowering procedure (p= 0.002). Most eyes with Ahmed implant (with or without CPC) maintained or improved their VA (100 and 63.6%, respectively). 33.3% of the eyes with laser CPC and 25% of those with no IOP-lowering intervention maintained or improved their VA (p = 0.028). Hypotony was the only adverse effect (after laser CPC). No statistically significant difference could be established between low VA (finger count or worse), poor IOP control, or bad metabolic control and mortality or cardiovascular event (p > 0.05), however, the four patients who died had poor VA at the time of NVG diagnosis. CONCLUSIONS Ahmed implant surgery is a safe and effective treatment option for diabetic NVG. Medical treatment alone is not the best option for most cases. Advanced NVG could be an indicator of higher mortality risk in diabetic patients.
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Affiliation(s)
- Sara Sánchez-Tabernero
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain, .,Moorfields Eye Hospital, London, United Kingdom,
| | - Jose R Juberías
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Núria Artells
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Sara Crespo-Millas
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carolina Meneses
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mª Fe Muñoz-Moreno
- Department Research, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Lucía Manzanas
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María I López Gálvez
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Ahmed Valves vs Trabeculectomy Combined with Pans Plana Vitrectomy for Neovascular Glaucoma with Vitreous Hemorrhage. Eur J Ophthalmol 2018; 27:774-780. [PMID: 28430329 PMCID: PMC6380088 DOI: 10.5301/ejo.5000973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Purpose Vitreous hemorrhage is common in advanced neovascular glaucoma (NVG), which
has poor visual prognosis. This study aimed to compare the efficacy of 23-G
pars planar vitrectomy (PPV) combined with either Ahmed glaucoma valve (AGV)
implantation or trabeculectomy after intravitreal ranibizumab (IVR)
treatment for NVG with vitreous hemorrhage. Methods This retrospective, nonrandomized study included 33 eyes of 33 patients with
NVG with vitreous hemorrhage. After IVR treatment for 3-7 days, 18 eyes
underwent PPV + AGV (AGV group) and 15 underwent PPV + trabeculectomy
(trabeculectomy group). The success criterion was a postoperative
intraocular pressure (IOP) of 6-21 mm Hg, with or without antiglaucoma
medication. Results Postoperative IOP decreased significantly in both groups, but the mean IOP
after 12 months was significantly lower in the AGV group (16.92 ± 2.75 mm
Hg) than the trabeculectomy group (21.50 ± 5.79 mm Hg; p = 0.018). The AGV
group required fewer glaucoma medications than the trabeculectomy group. The
cumulative probabilities of surgical success rates for the AGV and
trabeculectomy groups at 12 months were 71.3% and 46.7%, respectively. No
significant differences in postoperative complications were observed between
the groups. Conclusions For NVG with vitreous hemorrhage, PPV with AGV implantation may reduce IOP
more effectively than PPV with trabeculectomy.
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Katsanos A, Gorgoli K, Mikropoulos DG, Arranz-Marquez E, Athanasopoulos GP, Teus MA, Konstas AGP. Assessing the role of ranibizumab in improving the outcome of glaucoma filtering surgery and neovascular glaucoma. Expert Opin Biol Ther 2018; 18:719-724. [PMID: 29781319 DOI: 10.1080/14712598.2018.1479395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Ranibizumab was the first anti-vascular endothelial growth factor (VEGF) agent approved for the treatment of neovascular age-related macular degeneration. The use of ranibizumab and other anti-VEGF medications in recent years has revolutionized the treatment of several sight-threatening retinal disorders. Emerging evidence has demonstrated that anti-VEGF treatment can offer advantages in the management of other ocular conditions where VEGFs play a key role: ocular scarring following glaucoma filtering surgery and neovascular glaucoma (NVG). Areas covered: We critically review available evidence on the use of ranibizumab as a wound healing modulator in glaucoma filtering surgery and as an adjunct in the management of NVG. Expert opinion: Based on the available evidence and the authors' clinical experience, ranibizumab is a valuable adjunct in the management of NVG. In glaucoma filtering surgery, however, the role of ranibizumab is less clear and does not provide a significant advantage over mitomycin C. Drawbacks for its use in glaucoma include cost, its off-label use, uncertainty and limited evidence on the various routes of administration, the optimal dosing schemes and its toxicity profile. Future advances in ranibizumab delivery systems allowing less frequent dosing may change this treatment paradigm.
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Affiliation(s)
- Andreas Katsanos
- a Ophthalmology Department , University of Ioannina , Ioannina , Greece
| | - Kostantina Gorgoli
- b Sussex Eye Hospital , Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | | | - Esther Arranz-Marquez
- d Clínica Novovisión , Madrid , Spain.,e Ophthalmology Department , Rey Juan Carlos Universitary Hospital , Móstoles, Madrid , Spain
| | | | - Miguel A Teus
- d Clínica Novovisión , Madrid , Spain.,g Department of Ophthalmology , Hospital Universitario "Principe de Asturias", University of Alcalá , Alcalá de Henares , Spain
| | - Anastasios G P Konstas
- c 3rd University Department of Ophthalmology , AHEPA Hospital , Thessaloniki , Greece.,f 1st University Department of Ophthalmology , Aristotle University , Thessaloniki , Greece
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14
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Use of Anti-VEGF Agents in Glaucoma Surgery. J Ophthalmol 2017; 2017:1645269. [PMID: 28815088 PMCID: PMC5549503 DOI: 10.1155/2017/1645269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/01/2017] [Indexed: 12/15/2022] Open
Abstract
A number of antivascular endothelial growth factor agents are currently available to treat various ocular conditions. These agents have similar, but distinct, biologic qualities and have been explored in the management of neovascular glaucoma and in glaucoma surgery. Several different delivery methods are described, and because these medications are routinely given as intraocular injections, some benefits over traditional antifibrotic medications when used in glaucoma surgery are noted. These agents effectively induce regression of anterior segment neovascularization and facilitate initial surgical management of neovascular glaucoma, but the long-term outcome of this condition remains dependent on definitive management of the underlying process. Use in trabeculectomy or tube shunt procedures for other types of glaucoma has shown promise in modulating bleb morphology but has not yet been found to be as effective as traditional antifibrotic agents. There are reports of persistently raised intraocular pressure after repeated use of the anti-VEGF agents, possibly related to frequency of injection. These medications have wide application in the field of surgical glaucoma, but a definitive role has yet to be defined.
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15
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Sun JT, Liang HJ, An M, Wang DB. Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma. Int J Ophthalmol 2017; 10:400-405. [PMID: 28393031 DOI: 10.18240/ijo.2017.03.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/10/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of intravitreal ranibizumab (IVR) with panretinal photocoagulation (PRP) followed by trabeculectomy compared with Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG). METHODS This was a retrospective comparative study. We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included: diabetic retinopathy (25 eyes), and retinal vein occlusion (20 eyes). All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities (BCVA) were converted to the logarithms of the minimum angle of resolution (logMAR) for the statisitical analyses. Intraocular pressure (IOP), the logMAR BCVA and surgical complications were evaluated before and after surgery. The follow-up period was 12mo. RESULTS A total of 39 cases showed complete regression of iris neovascularization at 7d after injection, and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12mo after trabeculectomy and AGV implantation, respectively. In the trabeculectomy group, the logMAR BCVA improved at the last follow-up in 14 eyes, remained stable in 6 eyes and decreased in 2 eyes. In 4 cases, slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group, the logMAR BCVA improved in 14 eyes, remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases, and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery (F=545.468, P<0.05), and the mean postoperative logMAR BCVA was also significantly improved (F=10.964, P<0.05) with no significant difference between two groups. CONCLUSION It is safe and effective to treat NVG with this combined procedure, and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.
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Affiliation(s)
- Jin-Tao Sun
- Qingdao University, Qingdao 266000, Shandong Province, China; Department of Ophthalmology, Qingdao Economic and Technological Development Area First People's Hospital, Qingdao 266555, Shandong Province, China
| | - Hai-Jing Liang
- Department of Ophthalmology, Laixi People's Hospital, Qingdao 266600, Shandong Province, China
| | - Meng An
- Department of Ophthalmology, Qingdao Traditional Chinese Medical Hospital of Huangdao District, Qingdao 266500, Shandong Province, China
| | - Da-Bo Wang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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16
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Andrés-Guerrero V, Perucho-González L, García-Feijoo J, Morales-Fernández L, Saenz-Francés F, Herrero-Vanrell R, Júlvez LP, Llorens VP, Martínez-de-la-Casa JM, Konstas AGP. Current Perspectives on the Use of Anti-VEGF Drugs as Adjuvant Therapy in Glaucoma. Adv Ther 2017; 34:378-395. [PMID: 28000166 PMCID: PMC5331081 DOI: 10.1007/s12325-016-0461-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 12/14/2022]
Abstract
The approval of one of the first anti-vascular endothelial growth factor (VEGF) agents for the treatment of neovascular age-related macular degeneration one decade ago marked the beginning of a new era in the management of several sight-threatening retinal diseases. Since then, emerging evidence has demonstrated the utility of these therapies for the treatment of other ocular conditions characterized by elevated VEGF levels. In this article we review current perspectives on the use of anti-VEGF drugs as adjuvant therapy in the management of neovascular glaucoma (NVG). The use of anti-VEGFs for modifying wound healing in glaucoma filtration surgery (GFS) is also reviewed. Selected studies investigating the use of anti-VEGF agents or antimetabolites in GFS or the management of NVG have demonstrated that these agents can improve surgical outcomes. However, anti-VEGF agents have yet to demonstrate specific advantages over the more established agents commonly used today. Further studies are needed to evaluate the duration of action, dosing intervals, and toxicity profile of these treatments.
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Ocular neovascular-related diseases: immunological mechanisms of development and the potential of anti-angiogenic therapy. OPHTHALMOLOGY JOURNAL 2016. [DOI: 10.17816/ov9458-67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The paper adresses three ocular diseases - “wet” type of age-related macular degeneration, diabetic macular edema and neovascular glaucoma, which have similar neovascular changes and immunological disorders. The key moment of neovascularization development is an imbalance between pro- and anti-angiogenic factors. Particular attention is paid to vascular endothelial growth factor (VEGF-A), pigment epithelial derived factor (PEDF), transforming growth factor-beta (ТGF-β). The paper discusses the “immune privilege” of the eye, ACAID phenomenon, aspects of choroidal neovascularization pathogenesis, inflammation as an important part of neovascularization and the protective response to endogenous and exogenous damage, as well as complement system’s disorders, cytokine status impairment and autoimmune mechanisms. Laser treatment is widely used for treatment of neovascular diseases, but pharmacotherapy is very important too. Anti-angiogenic therapy is extremely promising and is held to provide regression of the newly-formed vasculature and/or normalization of newly formed blood vessels structure and suppress the functional activity of a key proangiogenic factor VEGF-A. Pegaptanib, ranibizumab and bevacizumab are discussed, and results of international clinical trials MARINA, ANCHOR, FOCUS, PrONTO, IVAN, CATT, RESTORE are provided.
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Prognostic Factor Analysis of Intraocular Pressure with Neovascular Glaucoma. J Ophthalmol 2016; 2016:1205895. [PMID: 27579175 PMCID: PMC4992518 DOI: 10.1155/2016/1205895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To perform multivariate analysis for identifying independent predictors of elevated intraocular pressure (IOP) with neovascular glaucoma (NVG), including antivascular endothelial growth factor (VEGF) intravitreal injections. Methods. We retrospectively reviewed 142 NVG patients (181 eyes) with ischemic retinal diseases [proliferative diabetic retinopathy (PDR) in 134 eyes, retinal vein occlusion (RVO) in 29, and ocular ischemic syndrome in 18]. We analyzed age, gender, initial/final LogMAR VA, initial/final IOP, extent of iris and/or angle neovascularization, treatments, preexisting complications, concurrent medications, and follow-up duration. Results. The mean follow-up duration was 23.8 ± 18.8 months. At the final follow-up, 125 (72.3%) eyes had IOP ≤ 21 mmHg. NVG patients with RVO had a higher degree of angle closure and higher IOP. NVG with PDR had better IOP and LogMAR VA. Angle closure had the greatest impact on final IOP. Greater than 90% of patients treated with trabeculectomy with mitomycin C (LEC) had persistent declines in IOP (≤21 mmHg). Stand-alone and combination anti-VEGF therapies were not associated with improved long-term prognosis of IOP. Conclusions. Angle closure was found to have the greatest effect on NVG-IOP prognosis. When target IOP values are not obtained after adequate PRP with or without anti-VEGF, early LEC may improve the prognosis of IOP.
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Liu L, Xu Y, Huang Z, Wang X. Intravitreal ranibizumab injection combined trabeculectomy versus Ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications. BMC Ophthalmol 2016; 16:65. [PMID: 27230388 PMCID: PMC4882850 DOI: 10.1186/s12886-016-0248-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/21/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Researches have shown anti-vascular endothelial growth factor (VEGF) agent is effective in treating neovascular eye diseases. The purpose of this study is to evaluate the efficacy and safety of intravitreal ranibizumab (IVR) injection combined trabeculectomy in the treatment of neovascular glaucoma (NVG), and compared it with Ahmed valve surgery. METHODS Thirty-six NVG patients (37 eyes) from the First Affiliated Hospital of Zhejiang medical college, between January 1, 2014 and January 31, 2015, were included in this prospective, interventional clinical study. Eighteen NVG eyes were given IVR injection one week before trabeculectomy. Ahmed valve implantation surgery was performed in nineteen eyes. Ocular pain, best corrected visual acuity (BCVA), intraocular pressure (IOP) and surgical complications were evaluated before and after the surgery. RESULTS IOP was significantly decreased following IVR injection combined trabeculectomy treatment (baseline 57.1 ± 8.9 mmHg; week 1, 15.2 ± 4.3 mmHg p = 0.000; month 1, 16.9 ± 2.1 mmHg p = 0.000; month 3, 20.3 ± 7.7 mmHg p = 0.000; month 6, 19.7 ± 7.3 mmHg p = 0.000). There was a significant, though modest, BCVA improvement in sighted eyes of IVR group (baseline 2.42 ± 0.68, W1 1.80 ± 0.91, P = 0.013; M1 1.77 ± 0.93, p = 0.011). IVR injection combined trabeculectomy had less postoperative complications and lower failure ratio than Ahmed surgery (IVR 5.6 %, Ahmed 31.6 %). CONCLUSIONS The study revealed that IVR injection combined trabeculectomy was an effective and safe treatment for NVG. Compared with Ahmed surgery, IVR injection combined trabeculectomy had less complications and higher success ratio. (Chinese Clinical Registry, TRN ChiCTR-OPN-16008147, 3/24/2016, retrospectively registered).
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Affiliation(s)
- Lan Liu
- Department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, People's Republic of China
| | - Yongfeng Xu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Zhu Huang
- Department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, People's Republic of China
| | - Xiaoyu Wang
- Department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, People's Republic of China.
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Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy. J Ophthalmol 2016; 2016:4108490. [PMID: 27293875 PMCID: PMC4884867 DOI: 10.1155/2016/4108490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/26/2016] [Accepted: 04/27/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To determine the efficacy of intravitreal ranibizumab injection as adjuvant therapy in the treatment of neovascular glaucoma (NVG) accompanied by postvitrectomy diabetic vitreous hemorrhage (PDVH). Methods. Eighteen NVG patients (18 eyes) accompanied by PDVH were enrolled in this prospective, monocenter, 12-month, interventional case series. The consecutive 18 patients with an IOP ≥ 25 mmHg despite being treated with the maximum medical therapy were treated with intravitreal ranibizumab injections. Vitreous surgery or/with Ahmed valve implantation were indicated if no clinical improvement in vitreous haemorrhage and uncontrolled IOP was shown. Results. Ten patients got clear vitreous and controlled IOP only with 2.7 ± 1.8 injections of ranibizumab without additional surgery. Vitrectomy or/with Ahmed valve implantation was administered in the other 8 eyes due to uncontrolled VH and IOP. At follow-up month 12, all the 18 eyes gained clear vitreous. At month 12 BCVA improved significantly compared to baseline. The baseline and follow-up at month 12 IOP/medication usage were 36.7 ± 8.1 mmHg on 3.4 ± 0.7 medications and 16.2 ± 4.9 mmHg on 0.67 ± 0.77 medications, respectively. Conclusions. The findings suggest that intravitreal ranibizumab injection as adjuvant therapy for treatment of NVG accompanied by PDVH may be safe and potentially effective. This clinical trial is registered with NCT02647515.
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The effects of VEGF-A-inhibitors aflibercept and ranibizumab on the ciliary body and iris of monkeys. Graefes Arch Clin Exp Ophthalmol 2016; 254:1117-25. [PMID: 27106625 DOI: 10.1007/s00417-016-3344-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/28/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To investigate the effects of intravitreal ranibizumab (Lucentis®) and aflibercept (Eylea®) on the ciliary body and the iris of 12 cynomolgus monkeys with regard to the fenestrations of their blood vessels. MATERIALS AND METHODS Structural changes in the ciliary body and in the iris were investigated with light, fluorescent, and transmission electron microscopy (TEM). The latter was used to specifically quantify fenestrations of the endothelium of blood vessels after treatment with aflibercept and ranibizumab. Each of the two ciliary bodies treated with aflibercept and the two treated with ranibizumab and their controls were examined after 1 and 7 days respectively. Ophthalmological investigations including funduscopy and intraocular pressure measurements were also applied. RESULTS Ophthalmological investigations did not reveal any changes within the groups. Both drugs reduced the VEGF concentration in the ciliary body pigmented epithelium. The structure of the ciliary body was not influenced, while the posterior pigmented epithelium of the iris showed vacuoles after aflibercept treatment. Ranibizumab was mainly concentrated on the surface layer of the ciliary epithelium, in the blood vessel walls and the lumen of some of the blood vessels, and in the cells of the epithelium of the ciliary body. Aflibercept was more concentrated in the stroma and not in the cells of the epithelium, but as with ranibizumab, also in the blood vessel walls and some of their lumina, and again on the surface layer of the epithelium. Both aflibercept-and ranibizumab-treated eyes showed a decreased number of fenestrations of the capillaries in the ciliary body compared to the untreated controls. On day 1 and day 7, aflibercept had fewer fenestrations than the ranibizumab samples of the same day. CONCLUSIONS Both aflibercept and ranibizumab were found to reach the blood vessel walls of the ciliary body, and effectively reduced their fenestrations. Aflibercept might eliminate VEGF to a greater extent, possibly due to a higher elimination of fenestrations in a shorter time. Moreover, the vacuoles found in the iris need further research, in order to evaluate whether they carry a possible pathological potential.
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Abstract
Vascular endothelial growth factor (VEGF) is a signaling protein, that controls vasculogenesis, angiogenesis, vascular support and stimulates permeability of small blood vessels. The following isoforms are presently known: VEGF-A, VEGF-B, VEGF-C, VEGF-В and PGF. VEGF-A, that regulates neoangiogenesis and fibroblast formation, is thought to play the most important role in human organism. Increased expression of VEGF may lead to development and aggravation of pathological conditions including oncology. The article presents a review of preclinical and clinical studies of the main VEGF-inhibitors - bevacizumab and ranibizumab, as well as a brief account on other existing medications of this group. It describes ophthalmological indications for the use of antiangiogenetic agents, as well as the ways of their possible off-label use. The review presents investigations of intravitreal and intracameral injections of VEGF-inhibitors in patients with retinal, chorioidal, iris, and anterior chamber angle neovascularization. It gives examples of successful anti-VEGF use before Ahmed glaucoma valve drainage device implantation and in cases of neovascular glaucoma, induced by radiation therapy for intraocular tumors. Tenon’s capsule’s fibroblasts take part in the process of postoperative wound healing and scarring. According to the latest research, this process could be modulated by angiogenesis inhibitors. This review also recounts the use of anti-angiogenic agents to inhibit postoperative fibroblast proliferation, when used as monotherapy, or as an adjuvant to mitomycin С or 5-fluorouracil. It reviews the research on VEGF-inibitors use in combination with postoperative needling.
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Li XJ, Yang XP, Li QM, Wang YY, Lyu XB. Ranibizumab Plus Combined Surgery for Treatment of Neovascular Glaucoma with Vitreous Hemorrhage. Chin Med J (Engl) 2016; 128:2078-83. [PMID: 26228222 PMCID: PMC4717954 DOI: 10.4103/0366-6999.161371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Neovascular glaucoma (NVG) is a refractory glaucoma. The management of NVG is very difficult, and it is more difficult when combined with vitreous hemorrhage. The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage. Methods: A total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study. The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years. The mean intraocular pressure (IOP) was 46.38 ± 5.75 mmHg (1 mmHg = 0.133 kPa) while being treated with the maximum medical therapy. The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution (logMAR BCVA) was 2.62 ± 0.43. All the patients underwent intravitreal injection of 0.5 mg (0.05 ml) ranibizumab combined with pars plana vitrectomy (PPV), pars plana lensectomy (PPL) with a preserved anterior capsule, panretinal photocoagulation (PRP), and trabeculectomy (intravitreal ranibizumab [IVR] + PPV + PPL + PRP + trabeculectomy). The IOP and logMAR BCVA were the main outcome measures in this study. Results: The follow-up period was 12 months. The mean postoperative IOPs were 26.38 ± 3.75 mmHg, 21.36 ± 3.32 mmHg, 18.57 ± 3.21 mmHg, and 16.68 ± 2.96 mmHg, respectively at 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy. At the last follow-up, the mean IOP was significantly lower than the preoperative one (t = 6.612, P = 0.001). At 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy, the mean logMAR BCVA were 1.30 ± 0.36, 1.29 ± 0.37, 1.29 ± 0.39, and 1.26 ± 0.29, respectively. At the last follow-up, the mean logMAR BCVA was significantly improved, and the difference was statistically significant compared with preoperative one (t = 6.133, P = 0.002). The logMAR BCVA improved in 22 eyes (84.62%), and remained stable in 4 eyes (15.38%). The neovascularization in the iris and the angle regressed significantly in all patients 7 days after ranibizumab injection. No serious complications occurred during 12 months of the study. Conclusions: IVR + PPV + PPL + PRP + trabeculectomy can control IOP well and improve BCVA without severe complication for NVG patients with vitreous hemorrhage.
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Affiliation(s)
- Xiu-Juan Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
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Tang M, Fu Y, Wang Y, Zheng Z, Fan Y, Sun X, Xu X. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma. BMC Ophthalmol 2016; 16:7. [PMID: 26749079 PMCID: PMC4707005 DOI: 10.1186/s12886-016-0183-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 01/04/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Neovascular glaucoma is a refractive glaucoma. Recently, anti-VEGF factors have been used alone or in combination for the treatment of neovascular glaucoma. However, the medium- and long-term efficacy of such drugs remains to be evaluated. This study was to determine the efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma. METHODS In this prospective non-randomized study, 43 neovascular glaucoma patients (43 eyes) were assigned to receive either 0.5 mg intravitreal ranibizumab for three to 14 days before Ahmed glaucoma valve implantation (injection group, n = 21) or Ahmed glaucoma valve implantation alone (control group, n = 22). The patients were followed up for six to 12 months. Differences in surgical success rate, intraocular pressure, best corrected visual acuity, anti-glaucoma medications and postoperative complications were compared between the two groups. Surgical success was defined as IOP > = 6 mm Hg and < = 21 mm Hg, with or without the use of anti-glaucoma medications, and without severe complications or reoperation. RESULTS Of the 43 patients, 40 completed the 6-month follow-up and 37 completed the 1-year follow-up. Success rate was 73.7% vs. 71.4% at six months and 72.2% vs. 68.4% at 12 months in the injection group and the control group respectively. No significant difference was noted between the two groups (six months: P = 0.87, 12 months: P = 1.00). There were no significant differences in the two groups with respect to intraocular pressure, best corrected visual acuity, anti-glaucoma medications or postoperative complications at six months or 12 months. CONCLUSIONS Single intravitreal ranibizumab (0.5 mg) before surgery has no significant effect on the medium- or long-term outcomes of neovascular glaucoma treated with Ahmed glaucoma valve implantation. TRIAL REGISTRATION Chinese Clinical Trial Registry ( ChiCTR-OOC-14005709, Trial registration date: 2014-12-01).
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Affiliation(s)
- Min Tang
- />Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, No.100 Haining Road, Hongkou District, Shanghai, 200080 China
| | - Yang Fu
- />Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, No.100 Haining Road, Hongkou District, Shanghai, 200080 China
| | - Ying Wang
- />Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200080 China
| | - Zhi Zheng
- />Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200080 China
| | - Ying Fan
- />Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200080 China
| | - Xiaodong Sun
- />Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200080 China
| | - Xun Xu
- />Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, No.100 Haining Road, Hongkou District, Shanghai, 200080 China
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Budzinskaya MV, Mazurina NK, Egorov AE, Kuroedov AV, Loskutov IA, Plyukhova AA, Razik S, Ryabtseva AA, Simonova SV. [Retinal vein occlusion management algorithm. Part 3. Neovascular complications]. Vestn Oftalmol 2015; 131:67-75. [PMID: 26977729 DOI: 10.17116/oftalma2015131667-75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neovascular complications severity in central/branch retinal vein occlusion (RVO) correlates with the level of occlusion and the degree of retinal perfusion disturbance. Large areas of retinal non-perfusion (more than half of the total retinal area) are associated with the risk for posterior segment neovascularization as high as 33% and for neovascular glaucoma - 45%. Over the past 30 years there has been an evident declining tendency of neovascular complications rates in the natural course of RVO. In ischemic RVO, anterior segment neovascularization is more aggressive than posterior. Neovascular glaucoma usually develops within the first 6 months of disease and correlates with uncontrolled arterial hypertension. Panretinal photocoagulation (PRP) is a standard treatment for anterior and posterior segment neovascularization in RVO patients. Anti-VEGF agents, if used as monotherapy, lead to rapid, however, short-term remission. Combination therapy, that is anti-VEGF injections and PRP, is the most effective. Intravitreal steroids have demonstrated no effect on ocular neovascularization. If PRP cannot be performed and intraocular pressure levels remain high, one should consider glaucoma drainage implant surgery. Preventive measures for neovascular complications that have proved effective so far include regular follow-ups, individually scheduled intravitreal injections, and PRP for large zones of ischemia.
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Affiliation(s)
- M V Budzinskaya
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N K Mazurina
- Posterior segment eye surgery and diagnostics center LLC, 2-aya Vladimirskaya St., Moscow, Russian Federation, 111123
| | - A E Egorov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997
| | - A V Kuroedov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997; Mandryka Clinical Research and Training Medical Center, 8A Bol'shaya Olen'ya St., Moscow, Russian Federation, 107014
| | - I A Loskutov
- Scientific Clinical Center of JSC Russian Railways, 20 Chasovaya St., Russian Federation, 125315
| | - A A Plyukhova
- 'SovMedTeh' LLC, Eximer clinic, 3-1 Marksistskaya St., Moscow, Russian Federation, 109147
| | - S Razik
- Medical diagnostic center 'Olimp' LLC, 77 Udal'tsova St., Moscow, Russian Federation, 119454
| | - A A Ryabtseva
- Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, 61/2 Shchepkina St., Moscow, Russian Federation, 129110
| | - S V Simonova
- S.P. Botkin State Clinical Hospital, Branch #1, Moscow Department of Public Health, 7 Mamonovskiy pereulok, Moscow, Russian Federation, 123001
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Angiogenesis in glaucoma filtration surgery and neovascular glaucoma: A review. Surv Ophthalmol 2015; 60:524-35. [PMID: 25980779 DOI: 10.1016/j.survophthal.2015.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 12/25/2022]
Abstract
Angiogenesis may pose a clinical challenge in glaucoma, for example, during the wound healing phase after glaucoma filtration surgery and in the severe secondary glaucoma called neovascular glaucoma (NVG). Upregulation of vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, occurs in eyes that have undergone glaucoma filtration surgery, as well as those with NVG. This has led investigation of the ability of anti-vascular endothelial growth factor therapy to improve outcomes, and we examine the findings with respect to the safety and efficacy of anti-vascular endothelial growth factor agents, mainly bevacizumab and ranibizumab, in eyes that have undergone glaucoma filtration surgery or have NVG. Combining conventional therapies-such as antimetabolites after filtration surgery and panretinal photocoagulation in NVG-and anti-vascular endothelial growth factor drugs may produce a synergetic effect, although further studies are required to evaluate the long-term efficacy of combination treatments.
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A Prospective Study to Evaluate Intravitreous Ranibizumab as Adjunctive Treatment for Trabeculectomy in Neovascular Glaucoma. Ophthalmol Ther 2015; 4:33-41. [PMID: 25812531 PMCID: PMC4470984 DOI: 10.1007/s40123-015-0033-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction The present study aimed to evaluate the effects of intravitreal ranibizumab (IVR) as adjunctive treatment for trabeculectomy with mitomycin C (TMC) in neovascular glaucoma (NVG). Methods This is a prospective study of 15 eyes from 14 consecutive patients with NVG carried out between December 2008 and December 2009. Each eye received IVR (0.5 mg/0.05 ml) 1 week before TMC. Trabeculectomy was performed with fornix-based conjunctival flap method. After TMC, additional panretinal photocoagulation (PRP), subconjunctival five fluorouracil injection, and bleb needling may be performed if indicated. The primary outcome measures were post-TMC intraocular pressure (IOP) and numbers of anti-glaucoma medication. The secondary outcome measures included of the recurrence of neovascularization at iris (NVI) and complications. Results Six eyes underwent adequate PRP before IVR but iris rubeosis still persisted. All eyes showed regression of NVI within 1 week after IVR. After TMC, mean IOP was significantly decreased from 37.9 mmHg preoperatively to 15.6 mmHg postoperatively (P < 0.001). Intraoperative hyphema was observed in four eyes. Thirteen eyes had controlled IOP (<21 mmHg) at last visit among which only one eye needed anti-glaucoma medication. Two eyes were considered as failure and needed further intervention. Visual acuity was maintained or improved in eight eyes. Recurrent NVI was not detected. All patients were symptom-free at last visit. Mean follow-up was 39 weeks. Conclusion IVR is an effective treatment adjunctive to TMC for NVG. The occurrence of intraoperative complications was low and the short-term outcomes after trabeculectomy were favorable. Electronic supplementary material The online version of this article (doi:10.1007/s40123-015-0033-3) contains supplementary material, which is available to authorized users.
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