scholarly journals Pre-trabeculectomy intravitreal injections of Bevacizumab for treating neovascular glaucoma in diabetic patients

2020 ◽  
Vol 77 (6) ◽  
pp. 637-640
Author(s):  
Ivan Marjanovic ◽  
Marjan Marjanovic ◽  
Ranko Gvozdenovic ◽  
Marija Marjanovic ◽  
Vujica Markovic ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Intravitreal Injections ◽  
Adjunctive Treatment ◽  
Diabetic Patients ◽  
Open Label ◽  
Intravitreal Bevacizumab Injection ◽  
The Mean

Background/Aim. Neovascular glaucoma (NVG) is a secondary glaucoma caused by occlusion of the trabecular network of newly formed blood vessels. The aim of this study was to evaluate the efficacy and safety of intravitreal injections of bevacizumab before trabeculectomy with mitomycin C (MMC) for the treatment of NVG. Methods. A prospective and open-label study was conducted from May 2013 to December 2014 on consecutive NVG patients who underwent intravitreal injections of bevacizumab and a primary trabeculectomy with MMC. All patients were followed-up at least for 12 months. Success was defined as an intraocular pressure (IOP) of ? 21 mm Hg with or without topical ocular hypotensive medication. Results. Fourteen eyes of 12 diabetic patients fulfilled the respective demands of the inclusion and exclusion criteria. The mean (? standard deviation) follow-up period was 15.0 (? 2.0) months (range, 12 to 19 months). After one year of follow-up, 11 (78.6%) eyes had an IOP ? 21 mmHg. The mean IOP was significantly reduced from 42.4 (? 9.7) mmHg preoperatively to 18.4 (? 2.9) mmHg postoperatively (p < 0.0001). Regarding surgical complications, 6 months of trabeculectomy, hyphaema was observed in 3 (21.4%) eyes, macular edema in one (7.1%) eye and recurrence of neovascularization requiring intravitreal bevacizumab injection in 2 (14.2%) eyes. Conclusion. Preoperative intravitreal bevacizumab may be effective as adjunctive treatment for trabeculectomy with mitomycin-C for neovascular glaucoma patients.

scholarly journals Combined Intravitreal Bevacizumab and Laser Photocoagulation to Treat Retinal Arterial Macroaneurysms

2021 ◽  
Vol 62 (8) ◽  
pp. 1053-1060
Author(s):  
Tae Hoon Kim ◽  
Chang Zoo Kim ◽  
Seung Uk Lee ◽  
Sang Joon Lee
Keyword(s):  
Visual Acuity ◽  
Laser Photocoagulation ◽  
Lipid Level ◽  
Intravitreal Bevacizumab ◽  
Macular Thickness ◽  
Intravitreal Bevacizumab Injection ◽  
Photocoagulation Treatment ◽  
The Mean ◽  
Bevacizumab Injection

Purpose: To investigate the effects of intravitreal bevacizumab injection combined with laser photocoagulation in patients with retinal microaneurysms.Methods: We retrospectively reviewed the medical records of 21 eyes of 21 patients who underwent intravitreal bevacizumab injection and/or laser photocoagulation to treat retinal macroaneurysms. Eleven eyes received the combination therapy (CT) and 10 eyes monotherapy (MT) (either bevacizumab injection or laser photocoagulation). Changes in visual acuity, central macular thickness, macroaneurysm size and location, blood pressure, and the lipid level were compared between the two groups.Results: The mean patient age was 74.0 ± 10.5 years and the mean study period 7.0 ± 5.3 months. The mean macroaneurysm diameter of the CT group was 480.00 ± 292.30 μm and that of the MT group 328.75 ± 87.09 μm. The diameter was significantly larger in the CT group (p = 0.002). The initial visual acuities were 0.91 ± 0.66 and 0.88 ± 0.83 in the CT and MT groups, respectively. At the 4-month follow-up, the visual acuities were 0.33 ± 0.26 and 0.17 ± 0.29 in the CT and MT groups, respectively, and had significantly improved only in the CT group (p = 0.042). The initial central macular thicknesses were 441.82 ± 226.81 and 541.63 ± 401.97 μm in the CT and MT groups, respectively. At the 4-month follow-up, the figures were 293.60 ± 46.10 and 269.00 ± 48.34 μm in the CT and MT groups, respectively, and had significantly decreased only in the CT group (p = 0.043). Compared to the initial findings, the proportion of patients whose final visual acuities improved by more than two lines were 73% and 40%, respectively, thus significantly higher in the CT group (p < 0.001).Conclusions: Combined intravitreal bevacizumab injection and laser photocoagulation treatment of retinal macroaneurysms improve visual acuity and decrease macular thickness.

scholarly journals Role of bevacizumab intraocular injection in the management of neovascular glaucoma

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.

Abstract 14317: Kidney Function Deterioration is Dependent on Blood Pressure Levels: 11.2-year Follow-up in Diabetic Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hirofumi SOEJIMA ◽  
Takeshi Morimoto ◽  
Sadanori Okada ◽  
Chisa Matsumoto ◽  
Masafumi Nakayama ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Diabetic Patients ◽  
Open Label ◽  
History Of ◽  
The Mean

Introduction: Blood pressure (BP) is a significant predictor for chronic kidney disease (CKD). Hypothesis: We sought to evaluate whether the progression of CKD in diabetic patients, without a history of atherosclerotic events, is dependent on BP control. Methods: The Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial was a multicenter, prospective, randomized, open label, blinded, end-point study done from 2002 to 2008. After completion of the JPAD trial, we followed up the patients until 2019. We defined late-stage kidney disease (LSKD) as estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m 2 or hemodialysis. Among 2,536 JPAD patients, 27 patients were excluded for eGFR <30ml/min/1.73m 2 on registration. BP of the JPAD patients was recorded on average 8 times. Based on the mean value of systolic BP (SBP), we divided the patients into three groups: a High BP Group (n=607, SBP≥140 mm Hg); a Moderate BP Group (n=989, 140>SBP≥130 mm Hg); or a Low BP Group (n=913, SBP<130 mm Hg). We compared the incidence of LSKD among the three groups. Results: The mean eGFR (ml/min/1.73m 2 ) was 75.1 in the High BP Group, 72.6 in the Moderate BP Group, and 75.7 in the Low BP Group on registration. During a 11.2-year follow-up, the incidence of LSKD was significantly higher in the High BP and Moderate BP Groups than in the Low BP Group (P<0.0018, Figure). Cox proportional hazards model analysis revealed that the High BP (HR, 1.57, P=0.049) and Moderate BP (HR, 1.52, P=0.037) were independent factors after adjustment for proteinuria≥±, age≥65 years, men, body mass index≥24 kg/m 2 , duration of diabetes ≥7.0 years, statin usage, aspirin usage, eGFR≥60 ml/min/1.73m 2 , and hemoglobin A1c ≥7.2 % (Figure). Conclusions: Our study demonstrated that SBP was independently associated with the progression to LSKD in diabetic patients, without a history of atherosclerotic events. SBP less than 130 mm Hg is recommended for diabetic patients to prevent progression to LSKD.

Can an Intraoperative Bevacizumab Injection Prevent Recurrent Postvitrectomy Diabetic Vitreous Hemorrhage?

2009 ◽  
Vol 19 (4) ◽  
pp. 618-621 ◽  
Author(s):  
Mario R. Romano ◽  
Syed Khurshid Gibran ◽  
Joaquin Marticorena ◽  
David Wong ◽  
Henrich Heimann
Keyword(s):  
Visual Acuity ◽  
Pars Plana Vitrectomy ◽  
Intravitreal Bevacizumab ◽  
Vitreous Hemorrhage ◽  
Diabetic Patients ◽  
Intravitreal Bevacizumab Injection ◽  
Pars Plana ◽  
Grade 3 ◽  
Bevacizumab Injection

Purpose To evaluate the recurrence of vitreous hemorrhage (VH) in patients treated with intravitreal bevacizumab (IVB) injection (2.5 mg/0.1 mL) intraoperatively at the end of vitrectomy for treatment of diabetic nonclearing VH. Methods A prospective pilot study of 30 eyes of 28 consecutive diabetic patients who underwent pars plana vitrectomy and IVB injection intraoperatively at the end of vitrectomy was performed. The amount of VH was graded with slit lamp biomicroscopy by three masked retinal specialists from grade 0 to grade 3. Main outcome measures were rate of recurrence of the VH, improvement in visual acuity, incidence of cataract formation, and postoperative complications through a follow-up of 6 months. Results The percentage of severe recurrent VH with no fundus details (grade 3) was 7%, 13%, 27%, and 30%, respectively, at 7 days and 1-, 3-, and 6-month follow-up. At 6-month follow-up, the best-corrected visual acuity improved from 1.00 to 0.4 logMAR (p=0.01) in 21 out of 30 eyes (70%). Nine out 20 (40%) phakic patients developed cataract during the follow-up period, and 7 (31%) of them underwent cataract surgery. Conclusions The study suggests that intravitreal bevacizumab injection cannot prevent rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous hemorrhage.

scholarly journals Neovascular Glaucoma Associated with Chronic Rhegmatogenous Retinal Detachment

2022 ◽  
Author(s):  
Dong Ik Kim ◽  
Se Joon Woo
Keyword(s):  
Retinal Detachment ◽  
Fluorescein Angiography ◽  
Carotid Artery Disease ◽  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Fundus Fluorescein Angiography ◽  
Intravitreal Bevacizumab Injection ◽  
Retinal Capillary ◽  
Retinal Reattachment

Abstract Background To demonstrate the clinical features and natural course of chronic retinal detachment associated neovascular glaucoma. Methods Ten patients, diagnosed with chronic retinal detachment-associated neovascular glaucoma during 2007-2016 were retrospectively investigated. Besides chronic retinal detachment, no patients had any neovascular glaucoma-predisposing conditions, such as carotid artery disease. Retinal perfusion status was evaluated from postoperative visual acuity, intraocular pressures, ocular examination findings, and fluorescein angiography images. Results The mean age of patients was 57.5 (range: 22-78) years. Complete retinal reattachment was achieved in 3 eyes, while partial or total chronic retinal detachment persisted in 7 eyes. Wide-angle fundus fluorescein angiography revealed peripheral retinal capillary obstruction and severe non-perfusion. Neovascular glaucoma developed 213.4 months (17-634 months) after retinal detachment. Three eyes received Ahmed valve implantation, while 5 eyes received intravitreal bevacizumab injection. Intraocular pressure was controlled in 10 eyes. Two eyes developed phthisis bulbi during follow-up. Conclusions In eyes with a chronic retinal detachment history, iris neovascularization and neovascular glaucoma can develop due to retinal capillary obstruction and chronic retinal ischemia, even after achieving retinal reattachment. We suggest routine follow-up examinations for patients with chronic retinal detachment, particularly for eyes with retinal non-perfusion, as detected on fundus fluorescein angiography.

scholarly journals Evaluation of Ellipsoid Zone Changes in Different Types of Diabetic Macular Edema After Intravitreal Bevacizumab Injection

2021 ◽  
Author(s):  
Utku Limon ◽  
Betul Ilkay Sezgin Akcay
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Inclusion Criteria ◽  
Ellipsoid Zone ◽  
Intravitreal Bevacizumab Injection ◽  
Group 4 ◽  
The Mean ◽  
Bevacizumab Injection

Abstract Purpose: To evaluate the ellipsoid zone (EZ) changes according to the types of diabetic macular edema (DME) on optical coherence tomography (OCT) after intravitreal bevacizumab injection. Methods: In this retrospective study, medical records of the patients who had treatment-naive DME and underwent intravitreal bevacizumab treatment between January 2015 and December 2021 were analyzed. Patients who meet the inclusion criteria and completed the follow-up period of 12 months were divided into 4 groups according to the types of diabetic macular edema on OCT (Diffuse DME [Group-1], cystoid DME [Group-2], diffuse DME with serous retinal detachment (SRD) [Group-3] and cystoid DME with SRD [Group-4]). Primary outcomes were EZ changes between the groups.Results: 125 eyes of 96 patients who fulfilled the inclusion criteria and completed the follow-up period were included in the study. There were no statistically significant differences in EZ improvements between the groups at 4, 6 and 12 months after treatment (p =0,594, p=0,836, p=0,486, p=0,748 respectively). The mean logMAR BCVA and CMT of all eyes showed significant improvement at 4, 6 and 12 months. When the mean CMT was compared between each groups, there were significant differences between the Group-1and Group-4 at 4, 6 and 12 months after treatment. (p<0,05)Conclusion: The BCVA gains and improvement in the CMT were maintained in all four DME types during the first year of intravitreal bevacizumab therapy. The improvement in EZ disruption was not depent on the type of DME and improved similarly in all groups.

Trabeculectomy in patients with diabetes: subconjunctival Mitomycin C with or without intravitreal bevacizumab

2020 ◽  
pp. bjophthalmol-2020-317324
Author(s):  
Naveed Nilforushan ◽  
Acieh Es'haghi ◽  
Arezoo Miraftabi ◽  
Navid Abolfathzadeh ◽  
Mahammad Banifatemi
Keyword(s):  
Mitomycin C ◽  
Success Probability ◽  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Cumulative Probability ◽  
Antiglaucoma Medication ◽  
Patients With Diabetes ◽  
Group A ◽  
The Mean ◽  
Group B

Background/aimsTo evaluate the success of Mitomycin C (MMC) augmented trabeculectomy with or without intravitreal bevacizumab in patients with diabetes without neovascular glaucoma.MethodsFifty-six patients with diabetes who needed trabeculectomy were randomised to either combination of 2.5 mg intravitreal bevacizumab and subconjunctival MMC (group A, 28 eyes) or subconjunctival MMC alone (group B, 28 eyes). The main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, bleb morphology and success probability. Surgical success was defined as complete according to two levels of IOP (≤18 and <15 mm Hg) and at least 20% reduction from preoperative IOP without antiglaucoma medications and qualified as complete success but with antiglaucoma medications. Total success was the sum of complete and qualified success.ResultsThe mean age was 65.2±12.9 and 67.4±10.2 years in groups A and B, respectively (p=0.50). All patients completed at least 1 year of follow-up. The mean 1-year IOP decreased from 25.2±12.0 mm Hg to 10.1±2.8 in group A and from 26.4±11.6 mm Hg to 15.2±6.9 in group B (all p<0.001). Overall, postoperative IOP measurement was statistically significantly lower in group A at month 12 (p=0.001). The number of medications in groups A and B at month 12 was 0.3±0.8 and 1.0±1.2, respectively (p=0.02). The cumulative probability of success at month 12 was not statistically significant (89.3% group A, 78.6% group B; p=0.27).ConclusionIn patients with diabetes with primary trabeculectomy, combined administration of intravitreal bevacizumab and subconjunctival MMC resulted in lower IOP and number of antiglaucoma medication compared with subconjunctival MMC alone.

scholarly journals Patient Preferences with Regard to Laser versus Intravitreal Injections in the Treatment of Diabetic Macular Edema

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Lauren Mason ◽  
Jason N. Crosson ◽  
John O. Mason ◽  
Gerald McGwin
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Effectiveness ◽  
Intravitreal Injections ◽  
Treatment Preference ◽  
Treatment Preferences ◽  
Diabetic Patients ◽  
The Mean ◽  
Injection Anxiety

Purpose. To identify treatment preferences of patients with diabetic macular edema (DME) having undergone laser and intravitreal injections. Methods. Patients with DME who received lasers and injections were surveyed, measuring preferences toward specific treatments. 66/210 diabetic patients met the criteria for our survey assessing preference for lasers and/or injections, incorporating demographics and treatment preference questions. Outcome measures included treatment preference (laser or injections), how often patients are willing to be treated, and how much vision they will sacrifice to avoid being treated every month. Results. 66 patients completed the survey. The mean diabetes duration was 20.7 years, the mean retina follow-up was 4.4 years, and patients received a mean of 4.82 lasers and 4.86 injections. 56% preferred injections, 33% preferred laser, and 11% had no preference. Regarding treatment effectiveness, 38% found no difference, 36% chose laser, and 25% chose injections. Regarding anxiety, 56% reported injection anxiety. While 50% versus 38% reported that laser was easier than injections. 91% would give up zero lines on the eye chart, and 76% would come in 12 times yearly for treatment to maintain vision. Conclusion. Patients with DME have no profound preference regarding laser versus intravitreal injections but prefer aggressive treatment and are unwilling to sacrifice vision for less visits.

scholarly journals Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation: 2-year follow-up

2014 ◽  
Vol 93 (1) ◽  
pp. e1-e6 ◽  
Author(s):  
Enyr S. Arcieri ◽  
Jayter S. Paula ◽  
Rodrigo Jorge ◽  
Kleyton A. Barella ◽  
Rafael S. Arcieri ◽  
...  
Keyword(s):  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Efficacy And Safety ◽  
Ahmed Glaucoma Valve ◽  
Valve Implantation ◽  
Ahmed Glaucoma Valve Implantation

Abstract P622: Racial Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alison L Herman ◽  
Adam H De Havenon ◽  
Guido J Falcone ◽  
Shadi Yaghi ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Hyperintensity ◽  
Diabetic Patients ◽  
Patient Race ◽  
Black Patients ◽  
The Mean ◽  
White Patients

Introduction: White matter hyperintensities (WMH) are linked to cognitive decline and stroke. We hypothesized that Black race would be associated with greater WMH progression in the ACCORDION MIND trial. Methods: The primary outcome is WMH progression in mL, evaluated by fitting linear regression to WMH volume on the month 80 MRI and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as “other” race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels. Results: We included 276 patients who completed the baseline and month 80 MRI, of which 207 were white, 48 Black, and 21 Hispanic. During follow-up, the mean number of SBP, LDL, and A1c measurements per patient was 21, 8, and 15. The mean (SD) WMH progression was 3.3 (5.4) mL for blacks, 2.5 (3.2) mL for Hispanics, and 2.4 (3.3) mL for whites. In the multivariate regression model (Table 1), Black, compared to white, patients had significantly more WMH progression (β Coefficient 1.26, 95% CI 0.45-2.06, p=0.002). Hispanic, compared to white, patients did not have significantly different WMH progression (p=0.392), nor was there a difference when comparing Hispanic to Black patients (p=0.162). The predicted WMH progression was significantly higher for Black compared to white patients across a mean SBP of 117 to 139 mm Hg (Figure 1). Conclusions: Black diabetic patients in ACCORDION MIND have a higher risk of WMH progression than white patients across a normal range of systolic blood pressure.

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