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K. J. Zamecki, R. M. Fischer, R. M. Lieberman; Outcomes in Eyes Treated With Intravitreal Bevacizumab (Avastin® ) and Panretinal Photocoagulation for Neovascular Glaucoma in a Diverse Clinic Population. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1224.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal bevacizumab [(Avastin®, Genetech corp.) (IVA)] has been used alone or in conjunction with panretinal photocoagulation (PRP) as a method of inducing regression of neovascularization (NV). We describe our experience with the use of IVA for rubeosis irides (RI) with or without neovascular glaucoma (NVG) in an ethnically diverse clinic population.
Retrospective chart review of patients receiving IVA (1.25mg/0.05ml) for RI and/or NVG from 4/2006 to 11/2007. Data collected included patient demographics, presence and etiology of RI and/or NVG, pre-and post-injection best-corrected visual acuity (BCVA), IOP, gonioscopy, and time to regression of RI. Long-term outcomes of IOP, surgical intervention and BCVA were assessed.
12 patients (17 eyes) were included; 7 male, 5 female, 2 White, 3 Asian, 6 Hispanic and 1 Black. Mean age was 62 yrs (range 24 to 83). Others followed for a mean of 3 months (range 1 week - 4 months).All eyes presented with RI; 11 had NVG. Two eyes progressed from RI to NVG during follow-up. 9/12 eyes had PRP placed. Seven patients with NVG were diabetic. Initial BCVA ranged from logMar -0.54 to LP; final BCVA from - 1.30 to NLP.All 11 eyes with NVG were initially treated medically, with 4 responding adequately, requiring no further intervention. Two patients treated medically had poor IOP control but declined further intervention. Three of the remaining 5 required an intraocular surgical procedure and 2 underwent diode cyclodestruction. Sealed angles were noted in 3/5 prior to IVA. 64% of eyes that had IVA and PRP had regression of RI within 1 month. Minimal changes were noted in long term BCVA and no statistically significant difference was noted between the medical and surgical groups.
IVA (1.25mg/0.05ml) is effective at causing regression of neovascularization when combined with PRP for anterior segment neovascularization. Medical management of IOP in NVG can be successful but surgical intervention was necessary in 45% of these patients. Long-term visual prognosis was poor.
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