Anti-VEGF for Management of Neovascularization of Iris and Neovascular Glaucoma

2018 ◽  
Vol 2 (4) ◽  
pp. 194-199
Author(s):  
Tian Xia ◽  
Marco A. Zarbin ◽  
Neelakshi Bhagat
Keyword(s):  
Retinal Vein Occlusion ◽  
Anterior Segment ◽  
Vitreous Hemorrhage ◽  
Corneal Edema ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
Complete Regression ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Purpose: To study the treatment effect of antivascular endothelial growth factor (anti-VEGF) injections on eyes with iris neovascularization (NVI). Methods: Retrospective study of patients who underwent intravitreal anti-VEGF for the treatment of NVI at the Rutgers-Institute of Ophthalmology and Visual Sciences between January 1, 2007 and March 30, 2017. Results: Twenty-eight eyes (mean age, 63 ± 13 years old, 12 [43%] males) were identified. All patients had NVI, and 23 patients had concurrent neovascular glaucoma. The etiology of anterior segment ischemia was proliferative diabetic retinopathy in 20 eyes (71%), central retinal vein occlusion in 7 eyes (25%), and branch retinal vein occlusion in 1 eye (4%). Corneal edema in 25 eyes (89%), hyphema in 11 (39%), visually significant cataract in 25 (86%), and vitreous hemorrhage in 15 (54%) precluded an adequate view to the fundus to perform panretinal photocoagulation (PRP). All patients initially received anti-VEGF therapy; PRP was provided in some eyes ( n = 7) with persistent NVI if the view to the fundus improved. On average, 1.66 (median, 1; standard deviation [SD], 1.64) anti-VEGF injections were performed before complete NVI regression was achieved. Complete regression of rubeosis iridis took an average of 42 (median, 40; SD, 48) days from the first injection. Ten eyes (36%) had recurrence of rubeosis at 198 (median, 126; SD, 165) days after complete regression of NVI. Conclusions: NVI regression was noted in all eyes. Anti-VEGF may be a good supplement for initial NVI management in eyes when PRP cannot be initiated.

Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in Central Retinal Vein Occlusion : Are Loading Dose Necessary ?

2019 ◽  
Vol 45 (1) ◽  
pp. 6
Author(s):  
Andi Arus Victor
Keyword(s):  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Anterior Segment ◽  
Fundus Examination ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Satisfactory Outcome ◽  
The Cost ◽  
Endothelial Growth Factor ◽  
Central Retinal Vein

Background : Ranibizumab (anti-VEGF) given monthly for six doses, is effective in central retinal vein occlusion (CRVO). However, the cost and adherence to complete Ranibizumab regiment is a burden for developing countries. Aim : To present two CRVO cases with satisfactory outcome after partial regiment of ranibizumab injections. Case presentation : A 52-year old male came with sudden, painless visual decline of the left eye (LE). Best corrected visual acuity (BCVA) was 0.4. Relative afferent pupillary defect (RAPD) was positive on LE. Anterior segment was normal. Fundus examination revealed a cup-disc ratio (CDR) of 0.4, macular edema (ME), scattered hemorrhages, dilated and tortuous retinal veins. Patient was diagnosed with CRVO and was given two monthly injections before stopping treatment. Patient came with worsened VA, was then given another injection. After 6 months, his BCVA was 0.8. Similarly, a 32- year old male came with sudden painless decline of vision of LE (BCVA 0.15). Anterior segment was normal. Fundus examination showed CDR of 0.3, ME, multiple scattered pre-retinal hemorrhages, dilated and tortuous retinal veins. Patient was similarly diagnosed with CRVO of LE and given two monthly injections. Final BCVA after six months follow-up was 0.9. Conclusion : Both cases showed improvement in VA despite having partial regiment of ranibizumab injections.

scholarly journals Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema

2021 ◽  
Author(s):  
Teruyo Kida ◽  
Josef Flammer ◽  
Katarzyna Konieczka ◽  
Tsunehiko Ikeda
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Retinal Vein Occlusion ◽  
Venous Pressure ◽  
Decisive Role ◽  
Retinal Venous Pressure ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract Purpose The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
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.

scholarly journals Use of Anti-VEGF Agents in Glaucoma Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Mark Slabaugh ◽  
Sarwat Salim
Keyword(s):  
Anterior Segment ◽  
Glaucoma Surgery ◽  
Neovascular Glaucoma ◽  
Delivery Methods ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Process Use ◽  
Anti Vegf ◽  
Repeated Use ◽  
Endothelial Growth Factor

A number of antivascular endothelial growth factor agents are currently available to treat various ocular conditions. These agents have similar, but distinct, biologic qualities and have been explored in the management of neovascular glaucoma and in glaucoma surgery. Several different delivery methods are described, and because these medications are routinely given as intraocular injections, some benefits over traditional antifibrotic medications when used in glaucoma surgery are noted. These agents effectively induce regression of anterior segment neovascularization and facilitate initial surgical management of neovascular glaucoma, but the long-term outcome of this condition remains dependent on definitive management of the underlying process. Use in trabeculectomy or tube shunt procedures for other types of glaucoma has shown promise in modulating bleb morphology but has not yet been found to be as effective as traditional antifibrotic agents. There are reports of persistently raised intraocular pressure after repeated use of the anti-VEGF agents, possibly related to frequency of injection. These medications have wide application in the field of surgical glaucoma, but a definitive role has yet to be defined.

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

2019 ◽  
Vol 3 (5) ◽  
pp. 309-316 ◽  
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.

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

2017 ◽  
Vol 1 (5) ◽  
pp. 298-304 ◽  
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.

scholarly journals Anti-VEGF Agents for Ocular Angiogenesis and Vascular Permeability

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Kenichi Kimoto ◽  
Toshiaki Kubota
Keyword(s):  
Intravitreal Injection ◽  
Neovascular Glaucoma ◽  
Therapeutic Window ◽  
Panretinal Photocoagulation ◽  
Drug Trials ◽  
Ocular Angiogenesis ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Stage 4 ◽  
Treatment Paradigm

We review articles describing intravitreal injection of anti-VEGF drug trials, while discussing the mechanisms of the action of anti-VEGF antibodies, and also evaluating their outcomes. Intraocular injections of anti-VEGF drug are considered to be an effective treatment for macular edema after retinal vein occlusion, however, recurrent/persistent edema is common. The recent reports may lead to a shift in treatment paradigm for DME, from laser photocoagulation, to newer approaches using anti-VEGF drugs. There have been several well-publicized prospective, randomized studies that demonstrated the efficacy of intravitreal injection of anti-VEGF drugs for patients with AMD. Adjuvant bevacizumab for neovascular glaucoma may prevent further PAS formation, and it is likely to open up a therapeutic window for a panretinal photocoagulation and trabeculectomy. Intravitreal injection of bevacizumab (IVB) results in a substantial decrease in bleeding from the retinal vessels or new vessels during a standard vitrectomy. IVB has also been reported to be effective for inducing the regression of new vessels in proliferative diabetic retinopathy. The use of bevacizumab in stage 4 or 5 retinopahty of permaturity (ROP) is to reduce the plus sign to help reduce hemorrhage during the subsequent vitrectomy. Some authors reported cases of resolution of stage 4 A ROP after bevacizumab injection.

scholarly journals Five-year outcomes of retinal vein occlusion treated with vascular endothelial growth factor inhibitors

2019 ◽  
Vol 4 (1) ◽  
pp. e000249 ◽  
Author(s):  
Kimberly Spooner ◽  
Samantha Fraser-Bell ◽  
Thomas Hong ◽  
Andrew A Chang
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Retinal Vein Occlusion ◽  
Macular Oedema ◽  
Vascular Endothelial ◽  
Fundus Fluorescein Angiography ◽  
Foveal Thickness ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Endothelial Growth Factor

PurposeReport 5-year outcomes of patients receiving anti-vascular endothelial growth factor (VEGF) for the treatment of macular oedema secondary to retinal vein occlusion (RVO.MethodsRetrospective review of eyes with RVO which initiated anti-VEGF treatment. Data including age, gender, visual acuity (VA) and injection numbers were obtained from medical records. Optical coherence tomography scans were graded for presence or absence of macular oedema and central foveal thickness (CFT). Macular perfusion was assessed on fundus fluorescein angiography by masked graders.Results68 eyes (31 branch RVO, BRVO; 35 central RVO, CRVO and 2 hemi-RVO) with 5 years of follow-up after initiation of anti-VEGF treatment. Mean change in VA at 5 years was + 9.6 ± 21.6 letters among CRVO eyes and + 14.2 ± 15.6 letters among eyes with BRVO (p=0.001). Vision of 20/40 or better was achieved in 65 % of treated eyes. The proportion of eyes with a three-line improvement of vision (15 letters) at 5 years was 22 %. Mean CFT decreased by 257.6 ± 249.8 µm in eyes with CRVO and 145.6 ± 143.3 µm in eyes with BRVO.ConclusionThe results confirm good long-term outcomes can be achieved with anti-VEGF therapy for RVO.

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