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Ramya Swamy, Vikas Chopra, Srinivas Sadda; Reduction in Long-term Vision Loss with Preoperative Bevacizumab for Neovascular Glaucoma Ramya Swamy, MD, MPH, Vikas Chopra, MD, Srinivas Sadda, MD Doheny Eye Institute, Dept of Ophthalmology, Keck School of Medicine, Los Angeles, CA. Invest. Ophthalmol. Vis. Sci. 2013;54(15):771.
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To evaluate the association between intraocular injection of bevacizumab before placement of glaucoma drainage implant (GDI) and objective outcomes in neovascular glaucoma.
A retrospective nonrandomized review was performed on all eligible patients with neovascular glaucoma (NVG) who presented to the Los Angeles County - University of Southern California (LAC-USC) Medical Center between 2007 and 2012. All subjects had newly diagnosed NVG with uncontrolled intraocular pressure (IOP) > 30mm Hg on maximally tolerated medical therapy. All subjects were determined to require surgery and underwent a valved GDI (Ahmed Glaucoma Valve, New World Medical, Rancho Cucamonga, CA). The decision to use intraocular bevacizumab (50 υl, 1.25 mg) was at the discretion of the treating physician. Baseline/preoperative variables collected included age, gender, etiology of neovascularization, IOP, visual acuity, and time to injection. Outcome measures included postoperative IOP and visual acuity at usual postoperative intervals and presence of an immediate postoperative hyphema. Characteristics and outcomes between groups were compared.
A total of 59 eyes were treated with a GDI during the study period. 8 eyes were excluded due to incomplete records. Of the remaining 51 eyes, 29 received intraocular bevacizumab injection before GDI (treatment group) and 22 underwent surgery without bevacizumab (control group). All patients received panretinal photocoagulation. In the treatment group, the mean time to injection was 7.06 days (confidence interval (CI): [0.81-13.27]). No statistically significant difference in IOP control, presence of hyphema, or visual acuity was observed at either postop week 1 or postop month 1 (p > 0.05). With longer term follow-up (> 6months), however, fewer eyes in the treatment group (6.89%) than in the control group (31.81%) progressed to no light perception (p = 0.02).
In our patient population, primarily consisting of complex cases of neovascular glaucoma with approximately three-fourths of the patients with baseline visual acuity at CF or worse, preoperative use of bevacizumab was associated with significantly less long-term progression to NLP vision despite equivalent IOP lowering with GDI placement.
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