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T. Tatsumi, Y. Nakamura, J. Uehara, T. Sugawara, Y. Mitamura, S. Yamamoto; Treatment of Neovascular Glaucoma by Simultaneous Cryoretinopexy and Intravitreal Injection of Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1359.
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Neovascular glaucoma (NVG) is a serious complication of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation is the standard treatment of NVG but it is not completely successful in stopping the neovascularization (NV). It was recently reported that an intravitreal injection of bevacizumab (IVB) led to a rapid and marked regression of the iris and angle NV. However, the effect of IVB is temporary and NV recurs in a high percentage of the eyes. The purpose of this study was to evaluate the effect of combining IVB and cryoretinopexy on the long-term outcome.
Eighteen eyes of 15 patients with NVG due to PDR (mean age, 59.8 years; range, 42-73 years old) received IVB (1.25 mg/0.05ml) and cryoretinopexy at the same time, and were followed for at least 12 months. Ophthalmic evaluations included measurement of the intraocular pressure (IOP), visual acuity, peripheral anterior synechiae (PAS) index, and presence of NV in the iris and angle.
In 14 (77.8%) of 18 eyes, the IOP was controlled without additional treatment except for anti-glaucoma drugs and retinal photocoagulation. The iris and angle NV regressed and disappeared rapidly in all eyes. The NV did not recur in 10 eyes at 12 months, and even if it recurred, the activity of the NV was low, and the IOP was 14 - 25 mmHg (mean; 18.6 mmHg) at 12 months. None of the eyes had an IOP <10 mmHg. In 4 eyes (22.2%), the IOP was not be controlled by the IVB/cryoretinopexy, and additional treatments other than retinal photocoagulation were required. Three of these four eyes had a trabeculectomy, and the other eye had diode laser cycloablation. In these four eyes, the IOP 12 months later was stable with a mean of 16.3±3.6 mmHg (range, 11-19 mmHg). The interval between cryoretinopexy/IVB and these additional treatments was 2-21 days. The visual acuity 12 months later had improved by >2 lines or remained unchanged in 16 (88.9%) of the 18 eyes.
These results indicate that combined IVB and cryoretinopexy led to a control of the IOP for at least 12 months in 80% of patients with NVG caused by PDR.
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