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Ananth Sastry, Christine Ryu, Hossein Ameri; Management and Outcomes of Anterior Segment Neovascularization. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5454.
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There is a dearth of evidence regarding treatment paradigms and outcomes in patients with anterior segment neovascularization (ASNV) without glaucoma. We therefore performed a retrospective observational clinical study to examine outcomes in patients with iris and/or angle neovascularization, and to identify any treatment regimens or risk factors that would affect the likelihood of progression from ASNV to NVG.
84 eyes with ASNV without NVG were identified in patients seen between 2005 and 2015 in Los Angeles County + University of Southern California Medical Center. Exclusion criteria included intraocular pressure >21 mm Hg, prior intraocular procedures; use of IOP lowering drops; or other visually significant ocular pathology. BCVA, IOP, presence of vitreous hemorrhage (VH) or tractional retinal detachment (TRD), and procedures performed were noted at date of presentation and follow up months 1, 2, 3, and 6. Patients were sorted into two groups based on the development of NVG within six months. A Two-Sample t-test was used to compare BCVA between the groups at each time point and to compare the number of intravitreal bevacizumab injections and PRP sessions received by the groups. Fisher’s exact test was used to compare the proportion of eyes in each group that presented with concurrent VH and TRD.
Within six months, 9 of the 84 eyes developed NVG. The final BCVA of eyes that developed NVG was significantly lower than those that didn’t (6ft/200 & 20/125, respectively; p=0.03). However, there was no significant difference in the proportion of eyes with concurrent VH (44% & 37%, p = 0.37) or TRD (11% & 5%, p = 0.33) on presentation. There was no significant difference in the demographics or cause of ASNV between the groups. There was no significant difference in the average number of PRP sessions (2.39 & 2.33, p = 0.45) or intravitreal bevacizumab injections (0.88 & 0.79, p = 0.32) performed over six months.
This is the first study to evaluate the management and outcomes of ASNV. Our study demonstrates that 11% of patients presenting with ASNV progress into NVG despite treatment with PRP and/or intravitreal bevacizumab. It further shows that patients who progress to NVG have a worse visual prognosis than those who don’t. We were unable to identify any significant risk factors or treatment regimens that impacted the probability of developing NVG; however, our study is limited by a small sample size.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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