Prognostic Factor Analysis of Intraocular Pressure with Neovascular Glaucoma

Purpose. To perform multivariate analysis for identifying independent predictors of elevated intraocular pressure (IOP) with neovascular glaucoma (NVG), including antivascular endothelial growth factor (VEGF) intravitreal injections.Methods. We retrospectively reviewed 142 NVG patients (181 eyes) with ischemic retinal diseases [proliferative diabetic retinopathy (PDR) in 134 eyes, retinal vein occlusion (RVO) in 29, and ocular ischemic syndrome in 18]. We analyzed age, gender, initial/final LogMAR VA, initial/final IOP, extent of iris and/or angle neovascularization, treatments, preexisting complications, concurrent medications, and follow-up duration.Results. The mean follow-up duration was 23.8 ± 18.8 months. At the final follow-up, 125 (72.3%) eyes had IOP ≤ 21 mmHg. NVG patients with RVO had a higher degree of angle closure and higher IOP. NVG with PDR had better IOP and LogMAR VA. Angle closure had the greatest impact on final IOP. Greater than 90% of patients treated with trabeculectomy with mitomycin C (LEC) had persistent declines in IOP (≤21 mmHg). Stand-alone and combination anti-VEGF therapies were not associated with improved long-term prognosis of IOP.Conclusions. Angle closure was found to have the greatest effect on NVG-IOP prognosis. When target IOP values are not obtained after adequate PRP with or without anti-VEGF, early LEC may improve the prognosis of IOP.

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Iridoplasty for plateau iris syndrome: a systematic review

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2019-000340 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000340

Author(s):

Hugo Bourdon ◽

Vittoria Aragno ◽

Christophe Baudouin ◽

Antoine Labbé

Keyword(s):

Systematic Review ◽

Intraocular Pressure ◽

Retrospective Studies ◽

Scientific Evidence ◽

Argon Laser ◽

Angle Closure ◽

Current Evidence ◽

Iridocorneal Angle

Plateau iris syndrome (PIS) is a frequent cause of angle closure. Argon laser peripheral iridoplasty (ALPI) has been proposed in PIS to widen the iridocorneal angle. The objective of the present study was to perform a systematic review of the available studies evaluating the efficacy of ALPI on intraocular pressure (IOP), iridocorneal angle opening and the number of medications in patients with chronic angle-closure associated with PIS. One prospective and seven retrospective studies with a minimum 1 month of follow-up were included. Although ALPI seemed to lower IOP, to decrease the number of topical antiglaucoma medications and widen the iridocorneal angle shortly after the procedure, there is no current evidence of long-term efficacy. To date, there is no robust scientific evidence to advocate ALPI as a treatment for chronic angle-closure caused by PIS.

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Aflibercept as Adjunctive Treatment for Filtration Surgery in Neovascular Glaucoma

Siriraj Medical Journal ◽

10.33192/smj.2022.4 ◽

2022 ◽

Vol 74 (1) ◽

pp. 27-33

Author(s):

Naris Kitnarong ◽

Janyawassamon Kittipiriyakul ◽

Anuwat Jiravarnsirikul

Keyword(s):

Neovascular Glaucoma ◽

Additional Treatment ◽

Adjunctive Treatment ◽

Panretinal Photocoagulation ◽

Vein Occlusion ◽

Corrected Visual Acuity ◽

Intravitreal Aflibercept ◽

The One ◽

Ischemic Syndrome

Objective: To investigate intravitreal aflibercept (IVA) injection as an adjunctive treatment to trabeculectomy with mitomycin C (TMC) and panretinal photocoagulation (PRP) for neovascular glaucoma (NVG).Materials and Methods: PRP and IVA (2 mg/0.05 ml) injection were given, and TMC was performed within 2weeks after IVA. Additional PRP, laser suture lysis, subconjunctival 5-fluorouracil injection, and bleb needlingwere performed after TMC if indicated. Best corrected visual acuity (BCVA), intraocular pressure (IOP), surgicalcomplications, and number of anti-glaucoma medications were collected.Results: Five eyes from 5 consecutive patients were included. Two eyes had proliferative diabetic retinopathy (PDR), 2 central retinal vein occlusion, and 1 ocular ischemic syndrome (OIS) (mean initial IOP: 46.8±6.8 mmHg). NVI regression occurred in one eye after PRP alone, and in one eye after PRP and IVA resulting in a good IOP control with topical medical therapy. The other 3 underwent TMC. The preoperative IOP was 34 (OIS), 54 (PDR), and 50 (PDR) mmHg. The 3-month postoperative IOP decreased to 8, 8, and 4 mmHg, respectively, and to 21, 10, and 6 mmHg, respectively, at the last visit. Only the one OIS eye required postoperative topical IOP-lowering medications. Final BCVA was improved, unchanged, and decreased in 2, 2, and 1 eye, respectively. No intraoperative/postoperative complications or NVI recurrence were observed (mean follow-up: 10.7 months).Conclusion: Intravitreal aflibercept was shown to be a potentially effective additional treatment to PRP and TMC in patients with NVG.

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The Effect of Antivascular Endothelial Growth Factor Therapy on the Development of Neovascular Glaucoma after Central Retinal Vein Occlusion: A Retrospective Analysis

Journal of Ophthalmology ◽

10.1155/2014/317694 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Christina L. Ryu ◽

Adrian Elfersy ◽

Uday Desai ◽

Thomas Hessburg ◽

Paul Edwards ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Significant Risk ◽

Case Series ◽

Neovascular Glaucoma ◽

Vein Occlusion ◽

Anti Vegf ◽

Central Retinal Vein

Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes.Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG.Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average.Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes.

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Disorganization of Retinal Inner Layers in Retinal Vein Occlusions: New Insights From Anti-VEGF Treatment

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418819697 ◽

2019 ◽

Vol 3 (5) ◽

pp. 309-316 ◽

Cited By ~ 1

Author(s):

Minh T. Nguyen ◽

Aline L.B. Martins ◽

Mia A. Heiligenstein ◽

Barbara A. Blodi ◽

Mihai Mititelu

Keyword(s):

Retinal Vein Occlusion ◽

Study Visit ◽

University Of Wisconsin ◽

Vein Occlusion ◽

Anti Vegf ◽

Significant Difference ◽

The University ◽

Endothelial Growth Factor ◽

Retinal Vein Occlusions

Purpose: The purpose of this study is to determine the significance of disorganization of the retinal inner layers (DRIL) in patients with retinal vein occlusions (RVOs) and whether this is influenced by the choice of antivascular endothelial growth factor (anti-VEGF) agent used. Methods: A retrospective chart study was conducted on patients with RVO and center-involved macular edema (ME) presenting to the University of Wisconsin with a minimum follow-up time of 12 months. Medical records were reviewed for demographics, vision, and imaging at baseline and 2 study visits over the course of 1 year. Two masked graders evaluated spectral-domain optical coherence tomography scans for DRIL and other features within the 1-mm-wide area centered on the foveal depression. Results: Twenty-two eyes had DRIL at baseline. DRIL resolved in 10 eyes at the first study visit, and in 2 more eyes at the second study visit. Although we could not establish an association between visual acuity (VA) and DRIL at baseline, we found a more robust correlation between DRIL extent and VA at baseline in eyes with central retinal vein occlusion/hemicentral vein occlusion compared to eyes with branch retinal vein occlusion. There was an association between DRIL improvement at the first study visit and VA improvement at the second study visit ( P = .049). However, this effect was smaller than the effect of initial VA improvement on final VA improvement. No significant difference in DRIL change was observed between the 3 anti-VEGF treatment algorithms: bevacizumab only, aflibercept only, and bevacizumab followed by aflibercept. Additionally, there was no significant correlation between RVO risk factors and change in DRIL over time. Conclusions: In our study, DRIL was not associated with VA in RVO-ME, but its resolution was predictive of VA improvement in response to anti-VEGF therapy. The choice of anti-VEGF agent (bevacizumab, aflibercept or a combination of the 2) did not affect the magnitude of DRIL resolution in RVO.

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Long-Term Visual Outcomes for a Treat-and-Extend Antivascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration: Up to Seven-Year Follow-Up

Journal of Ophthalmology ◽

10.1155/2020/3207614 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Simon Javidi ◽

Ali Dirani ◽

Fares Antaki ◽

Marc Saab ◽

Sofiane Rahali ◽

...

Keyword(s):

Growth Factor ◽

Age Related Macular Degeneration ◽

Intravitreal Injections ◽

Anti Vegf ◽

Endothelial Growth Factor ◽

Number Of Injections

Purpose. To report long-term visual and anatomical outcomes in eyes with neovascular age-related macular degeneration (nAMD) treated with a treat-and-extend regimen (TER) of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in real-world settings. Methods. Retrospective cohort study of consecutive patients with nAMD treated with a TER of anti-VEGF intravitreal injections by a single retina specialist (GC). Patients with nAMD who had at least one year of follow-up were identified using an electronic database. Best-corrected visual acuity (BCVA), comprehensive ophthalmologic examination, and macular OCT were performed at each visit. Patients received a loading dose of three monthly intravitreal injections and then were treated according to a TER of bevacizumab, ranibizumab, and/or aflibercept. The number of injections, BCVA, and central retinal thickness (CRT) were evaluated during the follow-up period. Results. 180 eyes from 180 patients were included in the study. Mean age was 75 ± 9 (range: 51–96). Mean BCVA was 0.77 ± 0.64 LogMAR at baseline, 0.69 ± 0.58 LogMAR (p=0.0057) after loading phase, 0.64 ± 0.55 LogMAR (p=0.0001) after 6 months of TER, and 0.76 ± 0.71 LogMAR after 6 years of treatment (n = 32 at year 6). CRT decreased significantly after the loading phase (p=0.0002). The mean number of intravitreal injections per year was 7.6 during the first three years of treatment and then decreased to 5.9 during year 4 to 7. Conclusions. This retrospective study of 180 nAMD patients treated with a TER of intravitreal anti-VEGF demonstrates an initial improvement of BCVA after loading phase, followed by long-term visual stabilization for at least six years. These results were obtained with a high number of injections, averaging close to six injections per year during long-term follow-up. In light of the natural evolution of nAMD, these data support the long-term efficacy of this treatment under real-world conditions of heterogeneity of patients and type of anti-VEGF used.

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Long-Term Outcomes of Anti-VEGF Therapy in Patients With Macular Edema Secondary to Retinal Vein Occlusion

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417721560 ◽

2017 ◽

Vol 1 (5) ◽

pp. 298-304 ◽

Cited By ~ 2

Author(s):

Jason M. Young ◽

Karen M. Wai ◽

Fabiana Q. Silva ◽

Felipe F. Conti ◽

Sunil K. Srivastava ◽

...

Keyword(s):

Clinical Practice ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Routine Clinical Practice ◽

Vascular Endothelial ◽

Vein Occlusion ◽

Anti Vegf ◽

Central Subfield Thickness ◽

Endothelial Growth Factor

Purpose: To evaluate long-term visual and anatomical outcomes of anti–vascular endothelial growth factor (VEGF) therapy for macular edema (ME) secondary to retinal vein occlusion (RVO) in routine clinical practice. Methods: Patients with ME secondary to hemi-RVO (HRVO), central RVO (CRVO), or branch RVO (BRVO) after initiating anti-VEGF therapy were followed for at least 36 months. Main outcomes were change in best visual acuity (BVA) and mean absolute change in central subfield thickness (CST) at 12, 24, 36, and 48 months. Results: Patients with BRVO showed significant increases in BVA that were maintained after 12, 24, 36, and 48 months (+11.03, +12.06, +10.71, and +9.26 letters, respectively; P < .05). CST significantly decreased after 12, 24, 36, and 48 months (−83.51, −67.93, −97.52, −127.85 µm, respectively; P < .05). In patients with CRVO/HRVO, significant improvements in BVA were seen at 12 and 24 months (+9.39 and +8.54 letters, respectively; P = .023). At 36 and 48 months, the visual gain was not significant (+2.64 and +3.42 letters, respectively; P > .05). For CST changes, there were significant decreases at 12, 24, and 36 months (−146.23, −149.54, and −166.44 µm, respectively; P < .05). At 48 months (−97.66 µm, P = .130), changes in CST were not significant. Conclusions: In routine clinical practice, visual and anatomical benefits of anti-VEGF agents in patients with BRVO were sustained at 36 and 48 months. For patients with CRVO/HRVO, anatomical improvements were maintained for 36, but not 48 months, while visual improvements were no longer maintained by 36 months.

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Evaluation of non-exudative microcystoid macular abnormalities secondary to retinal vein occlusion

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05250-9 ◽

2021 ◽

Author(s):

Anibal Francone ◽

Andrea Govetto ◽

Lisa Yun ◽

Juliet Essilfie ◽

Kouros Nouri-Mahdavi ◽

...

Keyword(s):

Retinal Vein Occlusion ◽

Glaucomatous Optic Neuropathy ◽

Vein Occlusion ◽

Anti Vegf ◽

History Of ◽

Group A ◽

Group B ◽

Endothelial Growth Factor ◽

Glaucoma Group

Abstract Purpose We aimed to investigate non-exudative microcystoid macular abnormalities for visual and anatomical outcome in patients with retinal vein occlusion (RVO) with and without glaucomatous optic neuropathy (GON). Methods Medical records of 124 eyes (105 patients) with RVO were reviewed and analyzed. Eyes demonstrating microcystoid macular abnormalities were divided into 2 groups, those with evidence of glaucoma (group A) and those without glaucoma (group B). Best-corrected visual acuity (BCVA), the prevalence and number of microcystoid macular abnormalities, and number of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections were compared at baseline and follow-up. Results Seventy-one out of 105 eyes (67.6%) with RVO displayed microcystoid macular abnormalities. Thirty-eight out of 71 eyes (53.5%) presented with concomitant glaucoma (group A), while the remaining 33 eyes (42.6%) had no history of glaucoma (group B). At the end of the follow-up period, mean BCVA was worse in group A versus group B (20/80 versus 20/40, respectively; p = .003). The mean number of anti-VEGF injections was 10.1 ± 9.2 in group A versus 5.9 ± 6.9 in group B (p = .03). Conclusion Eyes with RVO and concomitant glaucoma exhibited a significantly higher number of microcystoid macular abnormalities and worse BCVA versus eyes with RVO without glaucoma.

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Effect of Alternate Treatment with Intravitreal Corticosteroid and Anti-VEGF for Macular Edema Secondary to Retinal Vein Occlusion

Journal of Ophthalmology ◽

10.1155/2021/5948113 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Young Hwan Bae ◽

Seong Mi Kim ◽

Jin Young Kim ◽

So Hyun Bae ◽

Hakyoung Kim ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Visual Outcome ◽

Vascular Endothelial ◽

Vein Occlusion ◽

Anti Vegf ◽

Treatment Naïve ◽

Endothelial Growth Factor

Purpose. To evaluate whether treatment with intravitreal corticosteroid and anti-vascular endothelial growth factor (VEGF) injections alternately can improve treatment outcomes of macular edema (ME) caused by retinal vein occlusion (RVO). Methods. This dual-center retrospective study included 112 eyes with treatment-naïve ME secondary to RVO that were alternately treated with intravitreal corticosteroid and anti-VEGF injections (33 eyes, alternate group) or treated only with intravitreal anti-VEGF injections (79 eyes, anti-VEGF group) on a pro re nata basis. Results. During the 12-month follow-up period, the alternate group achieved a visual acuity gain of 0.39 logMAR, while the anti-VEGF group achieved a gain of 0.21 logMAR ( P = 0.042 ). The alternate group demonstrated a reduction in the central macular thickness of 229.9-μm, while the anti-VEGF group achieved a reduction of 220.1 μm ( P = 0.887 ). The alternate group required an average of 5.2 injections, while the anti-VEGF received 4.2 injections ( P < 0.001 ). In a propensity score-matched cohort to compensate for the differences in the injection numbers between the two groups, the alternate group achieved a better visual acuity gain than the anti-VEGF group at month 12 (0.39 logMAR vs. 0.17 logMAR, P = 0.048 ). Conclusions. In ME secondary to RVO, treatment with intravitreal corticosteroid and anti-VEGF injections alternately resulted in a more favorable visual outcome compared with intravitreal anti-VEGF monotherapy.

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Role of bevacizumab intraocular injection in the management of neovascular glaucoma

International Journal of Ophthalmology ◽

10.18240/ijo.2021.06.10 ◽

2021 ◽

Vol 14 (6) ◽

pp. 855-859

Author(s):

Fawaz Al Sarireh ◽

◽

Khalid Al Zubi ◽

Khalil Al Salem ◽

◽

...

Keyword(s):

Intraocular Pressure ◽

Intravitreal Bevacizumab ◽

Neovascular Glaucoma ◽

Retinal Ischemia ◽

Favorable Effect ◽

Complete Regression ◽

Long Term Effects ◽

Intravitreal Bevacizumab Injection ◽

Vein Occlusion

AIM: To assess the long-term effects of intraocular bevacizumab (Avastin) injections as an adjunctive drug to manage patients with neovascular glaucoma (NVG). METHODS: A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy (n=25), ischemic central retinal vein occlusion (n=8), and retinal ischemia resulting from persistent detachment (n=1) were managed by intraocular injections of bevacizumab (1.25 mg/0.05 mL), in addition to other treatments. The main outcome measure was the change in the degree of iris neovascularization. Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection. RESULTS: All patients were followed-up for at least 12mo. At the last follow-up, complete regression of rubeosis irides was detectable in 13 (38.2%) eyes and incomplete regression in 21 eyes (61.8%). The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit (P=0.000005). Patients received an average of 4.97 injections. As additional treatments, 12 eyes (35%) received laser photocoagulation and 6 eyes (18%) underwent retinocryopexy. No further treatment was needed in 16 eyes (47.1%). CONCLUSION: Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures. The primary cause of retinal ischemia should be always targeted.

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Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419878922 ◽

2019 ◽

Vol 4 (1) ◽

pp. 13-21

Author(s):

Jeannette Y. Stallworth ◽

Akshay S. Thomas ◽

Ryan Constantine ◽

Sandra S. Stinnett ◽

Sharon Fekrat

Keyword(s):

Growth Factor ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Treatment Patterns ◽

Vein Occlusion ◽

Anti Vegf ◽

Antivascular Endothelial Growth Factor ◽

Endothelial Growth Factor ◽

Central Retinal Vein

Purpose: This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed. Results: A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively. Conclusions: In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings.

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