Seminars in Ophthalmology
ISSN: 0882-0538 (Print) 1744-5205 (Online) Journal homepage: http://www.tandfonline.com/loi/isio20
Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma Rajen Tailor, Matt T. Kinsella & Jonathan C. Clarke To cite this article: Rajen Tailor, Matt T. Kinsella & Jonathan C. Clarke (2017): Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma, Seminars in Ophthalmology, DOI: 10.1080/08820538.2017.1375123 To link to this article: http://dx.doi.org/10.1080/08820538.2017.1375123
Published online: 09 Oct 2017.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isio20 Download by: [Australian Catholic University]
Date: 12 October 2017, At: 13:10
Seminars in Ophthalmology, Early Online, 1–7, 2017 © Taylor & Francis ISSN: 0882-0538 print / 1744-5205 online DOI: https://doi.org/10.1080/08820538.2017.1375123
ORIGINAL ARTICLE
Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma
Downloaded by [Australian Catholic University] at 13:10 12 October 2017
Rajen Tailor , Matt T. Kinsella, and Jonathan C. Clarke NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
ABSTRACT Background: To report the outcome of intravitreal Bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma in a patient group with extended follow-up. Methods: The records of 16 patients (18 eyes) with neovascular glaucoma refractory to medical therapy who presented to a single surgeon between 2006–2008 were reviewed. Patients received pan-retinal photocoagulation and then intravitreal Bevacizumab followed by Ahmed valve implantation. The main outcome measures were: control of IOP (with or without additional medication), visual acuity (VA) and failure (IOP >21 mmHg or 270 degrees PAS) (NVI-C). In the NVI group, IVB resulted
in a resolution of NVI within one week in all patients; however, there was a 44% recurrence rate within six months. In the NVI-O group, the mean IOP before IVB was 31.2 mmHg. Following IVB, regression of NVI and normalization of the IOP (≤21 mmHg) were seen in 71% of eyes within one week, with a mean IOP of 16.4 mmHg. However, recurrence of NVI and IOP elevation was observed in 58% of this group at a mean duration of 58 days following IVB, which required additional IVB and PRP. At final follow-up (13 months), 41% of eyes required surgery to lower the IOP. In the NVI-C group, the mean pre-IVB IOP was 44.9 mHg, with 93% of eyes requiring surgery within a mean of 11 days following IVB, despite resolution of the NVI. Hence, it appears that the efficacy of IVB to lower the IOP in NVG depends on the extent of angle closure. To date, a number of studies have described the use of AGV (with or without IVB) for the treatment of NVG, with the longest published mean follow-up being 27 months4 and 40.9 months12 with and without IVB, respectively (MMC not used). These studies are summarized in Table 3. In the present study, we report the longest mean follow-up of 63 months. Although there are no other studies published on the long-term outcome of IVB followed by AGV, two studies have reported their cumulative five-year success using AGV alone to be 20.6%11 and 25.2%.14 In comparison, our five-year success was 50%. In line with comparative studies, we excluded patients with previous cyclodestructive treatment, which has been shown to be equally as effective to AGV implantation in lowering the IOP.21 The use of IVB prior to AGV implantation in patients with NVG has been shown to reduce post-operative pain,7 hyphema and uveitis,6,15,16,20 and be associated with a comparatively better VA.20 However, the evidence for whether IVB improves the success rate of AGV in
Seminars in Ophthalmology
© 2017 Taylor & Francis
Retrospective
Retrospective Comparative Prospective, nonrandomized Prospective, randomized Retrospective comparative Retrospective (intraoperative MMC used) Prospective – randomized Retrospective case-control
Yalvac14
Sevim15
Yes (intra-op) Yes
Yes (pre-op) Yes (pre-op) Yes (pre-op) Yes (intra-op) Yes (pre-op)
No
14
20
25
20
20
20
19
38
20
19
38
6
27
15
15
16.2
12.5
16.5
37
25
40.9
17.4
Complete at 18 months – 80% Cumulative – 65% Cumulative – 71.4%
IOP ≥6 & ≤21 mmHg without AGS or LLP Complete at 18 months – 53.6% IOP ≥6 & ≤21 mmHg without AGS or LLP Cumulative – 60% IOP ≥6 & ≤21 mmHg without AGS or LLP Cumulative – 84.6%
-
-
IOP ≥6 & ≤21 mmHg without AGS or LLP IOP >5 &
ISSN: 0882-0538 (Print) 1744-5205 (Online) Journal homepage: http://www.tandfonline.com/loi/isio20
Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma Rajen Tailor, Matt T. Kinsella & Jonathan C. Clarke To cite this article: Rajen Tailor, Matt T. Kinsella & Jonathan C. Clarke (2017): Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma, Seminars in Ophthalmology, DOI: 10.1080/08820538.2017.1375123 To link to this article: http://dx.doi.org/10.1080/08820538.2017.1375123
Published online: 09 Oct 2017.
Submit your article to this journal
Article views: 2
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isio20 Download by: [Australian Catholic University]
Date: 12 October 2017, At: 13:10
Seminars in Ophthalmology, Early Online, 1–7, 2017 © Taylor & Francis ISSN: 0882-0538 print / 1744-5205 online DOI: https://doi.org/10.1080/08820538.2017.1375123
ORIGINAL ARTICLE
Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma
Downloaded by [Australian Catholic University] at 13:10 12 October 2017
Rajen Tailor , Matt T. Kinsella, and Jonathan C. Clarke NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
ABSTRACT Background: To report the outcome of intravitreal Bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma in a patient group with extended follow-up. Methods: The records of 16 patients (18 eyes) with neovascular glaucoma refractory to medical therapy who presented to a single surgeon between 2006–2008 were reviewed. Patients received pan-retinal photocoagulation and then intravitreal Bevacizumab followed by Ahmed valve implantation. The main outcome measures were: control of IOP (with or without additional medication), visual acuity (VA) and failure (IOP >21 mmHg or 270 degrees PAS) (NVI-C). In the NVI group, IVB resulted
in a resolution of NVI within one week in all patients; however, there was a 44% recurrence rate within six months. In the NVI-O group, the mean IOP before IVB was 31.2 mmHg. Following IVB, regression of NVI and normalization of the IOP (≤21 mmHg) were seen in 71% of eyes within one week, with a mean IOP of 16.4 mmHg. However, recurrence of NVI and IOP elevation was observed in 58% of this group at a mean duration of 58 days following IVB, which required additional IVB and PRP. At final follow-up (13 months), 41% of eyes required surgery to lower the IOP. In the NVI-C group, the mean pre-IVB IOP was 44.9 mHg, with 93% of eyes requiring surgery within a mean of 11 days following IVB, despite resolution of the NVI. Hence, it appears that the efficacy of IVB to lower the IOP in NVG depends on the extent of angle closure. To date, a number of studies have described the use of AGV (with or without IVB) for the treatment of NVG, with the longest published mean follow-up being 27 months4 and 40.9 months12 with and without IVB, respectively (MMC not used). These studies are summarized in Table 3. In the present study, we report the longest mean follow-up of 63 months. Although there are no other studies published on the long-term outcome of IVB followed by AGV, two studies have reported their cumulative five-year success using AGV alone to be 20.6%11 and 25.2%.14 In comparison, our five-year success was 50%. In line with comparative studies, we excluded patients with previous cyclodestructive treatment, which has been shown to be equally as effective to AGV implantation in lowering the IOP.21 The use of IVB prior to AGV implantation in patients with NVG has been shown to reduce post-operative pain,7 hyphema and uveitis,6,15,16,20 and be associated with a comparatively better VA.20 However, the evidence for whether IVB improves the success rate of AGV in
Seminars in Ophthalmology
© 2017 Taylor & Francis
Retrospective
Retrospective Comparative Prospective, nonrandomized Prospective, randomized Retrospective comparative Retrospective (intraoperative MMC used) Prospective – randomized Retrospective case-control
Yalvac14
Sevim15
Yes (intra-op) Yes
Yes (pre-op) Yes (pre-op) Yes (pre-op) Yes (intra-op) Yes (pre-op)
No
14
20
25
20
20
20
19
38
20
19
38
6
27
15
15
16.2
12.5
16.5
37
25
40.9
17.4
Complete at 18 months – 80% Cumulative – 65% Cumulative – 71.4%
IOP ≥6 & ≤21 mmHg without AGS or LLP Complete at 18 months – 53.6% IOP ≥6 & ≤21 mmHg without AGS or LLP Cumulative – 60% IOP ≥6 & ≤21 mmHg without AGS or LLP Cumulative – 84.6%
-
-
IOP ≥6 & ≤21 mmHg without AGS or LLP IOP >5 &
