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T. D. Albright, K. C. LaMattina, J. M. Roberts, P. MacIntosh, A. Desai, R. M. Ahuja; Long Term Follow-Up of Intravitreous Bevacizumab (Avastin) for Neovascular Glaucoma Secondary to Proliferate Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4236.
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To examine the visual acuity and intraocular pressure (IOP) outcomes of patients treated with intravitreous bevacizumab (Avastin) for neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR)
We conducted a retrospective study of patients receiving intravitreous injections of 1.25 mg per 0.05cc bevacizumab for NVG secondary to PDR at the Stroger Cook County Hospital Division of Ophthalmology. All eyes displayed neovascularization of the iris (NVI) and/or neovascularization of the angle (NVA) at presentation. Patients with NVG secondary to other causes were excluded. All patients enrolled gave informed consent including off-label use of bevacizumab. A complete ophthalmic examination was performed on initial examination, and follow-up was as medically indicated.
A total of 16 eyes of 16 patients were included in the study. Twelve patients were male, and 4 were female. The average age was 49.1 years (range 28-63). Ten were Hispanic, 3 White, and 3 African American. The mean and median number of intravitreous injections per eye was 2 (range 1-4). Average follow-up was 413 days (range 53-1000). Visual acuity at last examination improved in 1 eye (6%), remained the same in 9 (56%), and declined in 6 (38%). Final visual acuity ranged from 20/40 to no light perception. Intraocular pressure decreased in 14 eyes (86%) and increased in 2 (12%). All patients also had standard treatment for NVG. Twelve patients (75%) required glaucoma surgery. Six underwent alloplastic tube shunt surgery, 5 had cyclodestructive procedures, and 1 had both. No patients had adverse events secondary to the intravitreous bevacizumab.
Neovascular glaucoma is a rare complication of PDR, and traditional treatment regimens are often ineffective in halting or reversing vision loss. Adjunctive intravitreous bevacizumab helped to maintain or improve visual acuity in almost two thirds of our patients. This is rare in NVG. However, a majority of patients did require glaucoma surgery to manage IOP. No patients suffered adverse events from injection of intravitreous bevacizumab. Our average follow-up was greater than one year, which demonstrates long-term safety and efficacy of intravitreous bevacizumab with few injections. Further studies to examine visual acuity outcomes in patients with NVG secondary to PDR are warranted.
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