June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Salvaging the conventional outflow pathway in neovascular glaucoma (SCOPING) – Pilot results from a multidisciplinary treatment protocol
Author Affiliations & Notes
  • Jacob A. Kanter
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • David Dao
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Lincoln Shaw
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Anna Mackin
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Rahul Komati
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Pathik Amin
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Dimitra Skondra
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Mary Qiu
    Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Jacob Kanter None; David Dao None; Lincoln Shaw None; Anna Mackin None; Rahul Komati None; Pathik Amin None; Dimitra Skondra None; Mary Qiu None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3700 – A0385. doi:
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      Jacob A. Kanter, David Dao, Lincoln Shaw, Anna Mackin, Rahul Komati, Pathik Amin, Dimitra Skondra, Mary Qiu; Salvaging the conventional outflow pathway in neovascular glaucoma (SCOPING) – Pilot results from a multidisciplinary treatment protocol. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3700 – A0385.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : For NVI/NVG eyes with open angles, we propose a protocol to medically salvage the conventional outflow pathway and reduce the need for subsequent IOP-lowering surgeries. We also propose a novel strategy for utilizing GATT to surgically salvage the conventional outflow pathway in NVG eyes.

Methods : Patients with first-time NVI and/or NVA and at least partially open angles were treated with 6 intravitreal bevacizumab (IVB) injections interspersed with PRP at the discretion of the retina service. IVB injections were encouraged to be spaced by 28 days. Elevated IOP was treated at the discretion of the glaucoma service.

Results : Seven eyes from 6 patients were treated with SCOPING. The etiologies of NVG included PDR (5), CRVO (1), and OIS (1). The median presenting VA was 20/40 (range 20/25 to 20/1250). Median presenting IOP was 38 mmHg (range 15 to 47) on 0 meds at baseline. The median duration between IVBs was 35 days (range 23 to 77), and the median total duration from IVB#1 to IVB#6 was 203 days (range 152 to 224). The median number of PRP sessions during the protocol period was 3 (range 1 to 4). At 1 month after IVB #6, the median IOP was 15 mmHg (range 9 to 19) on median 0 meds (range 0 to 2). All 7 eyes had prompt regression of NVI/NVA and no recurrence throughout the protocol period. Five eyes had 100% open angles upon presentation; each maintained adequate IOP control without surgery. The 2 eyes with 50% PAS upon presentation developed progressive synechial closure; 1 patient elected GATT, and 1 elected Baerveldt 350 in the sulcus. After the protocol was completed, the eye with OIS developed NVA 80 days after IVB#6, and the eye with CRVO developed NVA 119 days after IVB#6. One eye with PDR developed vitreous hemorrhage 152 days after IVB #6 and received 4 subsequent IVB injections. The 5 eyes with PDR did not develop any recurrence of NVA after a median follow-up of 56 days (range 28 to 245) after IVB#6.

Conclusions : Our protocol demonstrates the value of aggressive anti-neovascular treatment for NVI/NVG with completely or partially open angles. In SCOPING, 6 monthly IVBs lead to immediate regression of NV while PRP exerts a long-term effect. If the angle develops partial synechial angle closure, GATT can be attempted to salvage the conventional outflow pathway if the patient and team are committed to close follow-up and ongoing treatment.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

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