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Maria Velazquez-Lamela, Neelakshi Bhagat, Marco A Zarbin, Albert S Khouri; Review of anterior segment neovascularization cases treated with intravitreal vascular endothelial growth factor inhibitors. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3003.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the role and treatment outcomes of anti-VEGF intravitreal injections for anterior segment neovascularization(NV) secondary to ischemic retinopathies
Patients with NVI and neovascular glaucoma(NVG) who received anti-VEGF injection for management of NV were selected between 2010 and 2015 at Rutgers-New Jersey Medical School. A retrospective review was done and the variables collected were: visual acuity(VA), presence of barriers to panretinal photocoagulation(PRP), history of previous PRP, intraocular pressure(IOP), etiology of ischemic retinopathy, and time to regression of NV. Only patients with a minimum of 3 months(mo) of follow up after injection were included in the study
Fourteen eyes of 13 patients were identified and met inclusion criteria for the study. Of the 13 studied, 3 eyes had NVI only and 11 eyes had NVG with an mean total follow up time of 13.5mo(r: 3-35) after injection. The etiologies of ischemia were diabetic retinopathy(n=11) and retinal vein occlusions(n=3). Barriers to PRP found in 71.4% of all eyes at time of injection included vitreous hemorrhage, cataract, and corneal edema. Ranibizumab 0.5mg was used in 1 eye and the remaining 13 eyes were treated with Bevacizumab 1.25mg. Rubeosis regressed in all NVI only eyes after 1 injection at a mean of 3mo(r: 2-5). No progression to NVG was noted in these eyes at a mean f/u of 6.6mo. NVG eyes without prior PRP(n=5) all had a barrier to PRP; 4/5 had regression of NVI but 3 of these had recurrence of NVI at mean of 8mo. 100% of partial PRP eyes with NVG(n=2) regressed at mean of 4mo(r:3.5-4.5) and NVI did not reccur at a mean 15mo after injection. Eyes with NVG and complete PRP(n=4) also had 100% regression at mean of 1.4mo(r:0.75-2) and had no recurrence at mean of 13.6mo. Out of all NVG eyes, 8 had additional PRP given after injection, on average started 3 weeks after. Mean IOP change of -4.3mmHg(r:-22 to +16) was achieved in a subgroup of NVG eyes with drops but no glaucoma surgery or laser(n=7) through f/u period. All eyes in both NVI and NVG groups with prior PRP(partial/complete n=9) were found to have regression of NV at mean 2.6mo(r:0.75-5), no recurrence after mean of 11.6mo and 78% had stable or better VA
Intravitreal anti-VEGF may be an alternative to initiate treatment for NVI and NVG in patients with barriers to PRP pending resolution to such barriers
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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