ABSTRACT
Rationale. Neovascular glaucoma is the type of glaucoma most refractory to treatment. The most frequent causes are those associated with retinal hypoxia, which promotes the upregulation of the VEGF synthesis and produces fibrovascular membranes over the anterior chamber angle. Because the administration of anti VEGF products is still off label for neovascular glaucoma, there is not a single accepted way of treatment. There are differences between the site of administration (vitreal or anterior chamber or both at the same time), the dose or the setting of the procedure. Objective. The objective of our study was to asses the difference of efficacy and complications of bevacizumab injection for vitreal administration versus anterior chamber administration. Methods and results. Prospective study with 18 eyes from 18 patients with neovascular glaucoma associated with proliferative diabetic retinopathy or retinal vein occlusion. Group A (10 patients) received intravitreal injection with 0.05 ml Bevacizumab. Group B (8 patients) received anterior chamber injection with 0.03 ml Bevacizumab. There was a significant decrease of intraocular pressure (p<0.01 for group A, p<0.05 for group B) for both groups. Group A also had a statistically significant decrease of the macular edema (p<0.05). The side effects were reduced for both groups. Discussion. Our conclusion was that for the neovascular glaucoma, which associates significant macular edema, the intravitreal procedure should be performed, while for neovascular glaucoma patients without retinal edema, the anterior chamber procedure should be preferred because of reduced potential side effects.
Subject(s)
Bevacizumab/adverse effects , Bevacizumab/therapeutic use , Glaucoma, Neovascular/drug therapy , Adult , Aged , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/adverse effects , Angiogenesis Inhibitors/therapeutic use , Anterior Chamber/drug effects , Bevacizumab/administration & dosage , Female , Glaucoma, Neovascular/physiopathology , Humans , Intraocular Pressure/drug effects , Intravitreal Injections , Male , Middle Aged , Treatment OutcomeABSTRACT
Rationale. Neovascular glaucoma is the type of glaucoma most refractory to treatment. The most frequent causes are those associated with retinal hypoxia, such as proliferative diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, central retinal arterial occlusion, ischemic ocular syndrome etc. Rare causes of neovascular glaucoma are multiple and are due to VEGF synthesis associated with chorioretinal inflammations or degenerations. We present a case with neovascular glaucoma associated with an extremely rare cause, angioid streaks Objective. The objective of our prsentation was to asses efficacy of the 5-FU associated trabeculectomy following bevacizumab intravitreal administration Methods and results. Case report of a 48 years old female patient which presented at the emergency room with painful red left eye. At presentation best corrected left eye visual acuity was 1/10, intraocular pressure was 36 mm Hg. Examination established the diagnosis of Neovascular glaucoma associated with angioid streaks. After intravenous Manitol, oral Acetazolamide and topical treatment with fixed combination timolol-brinzolamide, topical steroid and mydriatic intraocular pressure decreased. Intravitreal bevacizumab injection was performed, followed after 3 weeks by trabeculectomy. Discussion. Angioid streaks are an extremely rare cause of neovascular glaucoma. The treatment is similar to the treatment for other causes of neovascular glaucoma.
