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T. A. Landry, J. Dickerson, J. C. Merriam; The Use of Anecortave Acetate for Refractory, Complex Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1206.
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When the control of intraocular pressure (IOP) is inadequate or adherence with multiple medications is difficult, surgery may be indicated. Patients who have had multiple procedures may be reluctant to have additional surgery, especially if they have significant medical problems. When the outcome from additional surgery is uncertain, the surgeon may be reluctant to recommend operation. This retrospective review summarizes one physician's experience with Anecortave Acetate (AA) for patients with complex glaucomas.
With an IND from the FDA and approval by the IRB, 8 patients received an anterior juxtascleral injection of 12 or 24 mg Anecortave Acetate with topical anesthesia. Baseline testing included 24-2 Humphrey visual field, OCT scan of the optic nerve and macula, gonioscopy, corrected visual acuity, corneal pachymetry, applanation tonometry, and slit lamp and fundus examinations. IOP was measured before and after injection, the day after injection, after 1 and 2 weeks, and monthly thereafter. All eyes were pseudophakic (6 phaco, 1 ECCE, 1 ICCE) and had been treated with laser trabeculoplasty; 4 had at least one filtering procedure; 2 had a penetrating keratoplasty; 2 had pars plana vitrectomy; and all were on maximal medical therapy.
One patient had a small subconjunctival hemorrhage from the injection; there were no other injection complications. Two patients with baseline IOP over 30 mm Hg who had refused additional surgery did not reach target pressure after AA and subsequently had an Ahmed valve. One patient with severe medical problems, a vein occlusion, and a baseline IOP of 50 refused any procedure. After injection IOP varied from 40 to 50. One patient, treated with 12 mg to one eye and 24 mg to the other, with a baseline IOP in the low 20’s OU, had a decline of about 10% OU. The 3 other patients all had glaucomas complicated by iritis and a steroid response. Two had recurrent graft rejection, and one had severe anterior and posterior uveitis, possibly associated with tuberculosis, diabetic retinopathy and vein occlusion. These three patients had a reduction from baseline IOP of more than 30% and a reduction in medications.
Patients with complex glaucomas and a steroid induced rise in IOP may benefit from AA. Administration of the drug as a juxtascleral depot is safe and well tolerated. Optimal dosing remains to be determined.
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