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M. Ariga, R. Murali, S. Mohan, M. Rajan; Intracameral Bevacizumab as a Primary Treatment for Iris Neovascularisation of Varying Etiologies. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4583.
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To assess the short term efficacy and safety of intracameral bevacizumab on iris neovascularisation(NVI) in patients with proliferative and ischemic retinopathies
Nine eyes of eight patients with NVI received 1.25 mg intracameral bevacizumab. The cause for neovascularisation in these eyes were proliferative diabetic retinopathy (3 eyes), ischemic central retinal vein occlusion (2 eyes), ocular ischemic syndrome (2 eyes), Coats disease (1 eye), proliferative vitreoretinopathy in an eye with high myopia (1 eye).One patient with ocular ischemia syndrome and bilateral NVI received the injection in both eyes on different dates. The age of the patients ranged from 38 years to 65 years.Best corrected visual acuities before injection ranged from perception of light (PL +) to 6/60 (20/200). NVI was grade 2 in 2 eyes, grade 3 in 2 eyes and grade 4 in 5 eyes. Neovascular glaucoma (NVG) was present in 7 eyes. All these patients were newly diagnosed NVG patients. 2 eyes had previous history of vitreoretinal surgery. Intracameral injection was repeated in 2 eyes after 4 weeks. The main outcome measurements were visual acuity, anterior chamber inflammation, clinical regression of NVI and intraocular pressure (IOP) over a followup period ranging from 4 weeks to 14 weeks
Complete clinical regression of NVI was seen in 2 eyes with grade 2 NVI within one week. There was a decrease in anterior chamber reaction in 2 eyes. There was considerable regression in the caliber and number of new vessels in the angle and on the iris surface in all but one eye. IOP decrease ranging from 18 mm to 1 mm was noted in patients with NVG. Glaucoma medication was prescribed in all patients with NVG following the injection. A repeat injection was given for the persistence of NVI in two eyes. No adverse events were observed during or after the procedure.Phacoemulsification followed by panretinal photocoagulation was done in one eye.
Intracameral bevacizumab was useful and safe as a primary treatment in eyes with NVI and NVG. It helps reduce the anterior chamber reaction and causes regression of NVI in early stages and may prevents the progression of iris neovascularisation in the later stages. Intracameral bevacizumab may also prevent the onset of a painful blind eye due to secondary angle closure glaucoma.
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