Journal of Current Glaucoma Practice

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VOLUME 16 , ISSUE 1 ( January-April, 2022 ) > List of Articles

ORIGINAL RESEARCH

A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma

Jaya Kaushik, Jitendra KS Parihar, Rakesh Shetty, Piyush Chaturvedi

Keywords : Ahmed glaucoma valve, Anti-VEGF with AGV implantation in NVG, Decreased postoperative complications with ranibizumab in AGV implantation for NVG, ranibizumab with AGV implantation in NVG, ranibizumab in NVG

Citation Information : Kaushik J, Parihar JK, Shetty R, Chaturvedi P. A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma. J Curr Glaucoma Pract 2022; 16 (1):41-46.

DOI: 10.5005/jp-journals-10078-1355

License: CC BY-NC 4.0

Published Online: 03-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Purpose: This study was aimed to gauge the efficacy of primary AGV implantation with concurrent intraoperative intravitreal ranibizumab vs primary AGV implantation alone in the management of neovascular glaucoma (NVG). Methods: This retrospective comparative study was carried out based on the data collected in patients of neovascular glaucoma who underwent Ahmed Glaucoma Valve implantation with or without concurrent intravitreal ranibizumab between the period from Feb 2009 to Feb 2015 involving two groups of 40 patients each, having the clinical diagnosis of neovascular glaucoma, having undergone pan-retinal photocoagulation with minimum 03 intravitreal injections of ranibizumab not less than 4 weeks prior to undergoing primary Ahmed glaucoma valve implantation and allotted randomly to either group to receive concurrent administration of intravitreal ranibizumab with Ahmed glaucoma valve (AGV) implant surgery or AGV implant surgery alone. The minimum qualifying follow-up was 3-years. The functional outcome measures included intraoperative and postoperative complications, intraocular pressure (IOP), and the need for antiglaucoma medication, if any, as well as best corrected visual acuity. Results: Both the groups showed a significant decrease in IOP (p < 0.05). Sight and IOP threatening postoperative complications were significantly low in the study group. NVI regression was higher in the study group and re-emergence was significantly lesser in the study group (p = 0.002). Mean postop IOP had shown an excellent reduction in IOP up to 14.25 ± 2.05 mm Hg with 1.5 ± 1 antiglaucoma drugs in ranibizumab group and 15.25 ± 2.95 mm Hg with 1.7 ± 0.87 antiglaucoma drugs in the control group at the 3-years follow-up period. Surgical success rates were comparable between the two groups at 1 and 3-year. Conclusion: Concurrent intravitreal ranibizumab along with primary AGV implantation minimizes postoperative complications, regresses NVI while accelerating stabilization of IOP and visual functions.


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  1. Hayreh SS. Neovascular glaucoma. Prog Retin Eyes Res 2007;26(319):470–485. DOI: 10.1016/j.preteyeres.2007.06.001
  2. Havens SJ, Gulati V. Neovascular glaucoma. Dev Ophthalmol 2016;55:196–204. DOI: 10.1159/000431196
  3. Sivak-Callcott JA, O'Day DM, Gass JD, et al. Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology 2001;108(10):1767–1776. DOI: 10.1016/s0161-6420(01)00775-8
  4. Iliev ME, Gerber S. Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma. Br J Ophthalmol 2007;91(12):1631–1635. DOI: 10.1136/bjo.2007.116533
  5. Wang MH, Li QM, Dong HT, et al. Ahmed valves vs trabeculectomy combined with pans plana vitrectomy for neovascular glaucoma with vitreous hemorrhage. Eur J Ophthalmol 2017;27(6):774–780. DOI: 10.5301/ejo.5000973
  6. Sisto D, Vetrugno M, Trabucco T, et al. The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate–term follow–up. Acta Ophthalmol Scand 2007;(Mmc):267–271. DOI: 10.1111/j.1600–0420.2006.00810.x
  7. Parihar JKS, Vats DP, Maggon R, et al. The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes. Indian J Ophthalmol 2009;57(5):345-350. DOI: 10.4103/0301–4738.55068
  8. Kaushik J, Parihar JKS, Jain VK, et al. Ahmed valve implantation in childhood glaucoma associated with sturge–weber syndrome: our experience. Eye 2018;33(3):464–468. DOI: 10.1038/s41433-018-0233-x
  9. Erçalik NY, İmamoğlu S. Ahmed glaucoma valve implantation in vitrectomized eyes. J Ophthalmol 2018;2018:9572805. DOI: 10.1155/2018/9572805
  10. He Y, Tian Y, Song W, et al. Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors. Medicine (Baltimore) 2017;96(42):e8350. DOI: 10.1097/MD.0000000000008350.
  11. Bikbov MM, Khusnitdinov II. The results of the use of Ahmed valve in refractory glaucoma surgery. J Curr Glaucoma Pract 2016;9(3):86–91. DOI: 10.5005/jp–journals–10008–1191
  12. Shah MR, Khandekar RB, Zutshi R, et al. Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman. J Ophthalmol 2013;6(1):27–32. DOI: 10.4103/0974–620X.111905
  13. Ferrara N. Vascular endothelial growth factor: basic science and endocr and clinical progress. Endocr Rev 2004;25(4):581–611. DOI: 10.1210/er.2003–0027
  14. Homayouni M. Vascular Endothelial Growth Factors and Their Inhibitors in Ocular Neovascular Disorders. Vol 4.; 2009. www.clinicaltrials.gov. Accessed May 3, 2020.
  15. Tripathi RC, Li J, Tripathi BJ, et al. Increased level of vascular endothelial growth factor in aqueous humor of patients with neovascular glaucoma. Ophthalmology 1998;105(2):232–237. DOI: 10.1016/S0161–6420(98)92782–8
  16. Lüke J, Nassar K, Lüke M, et al. Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma - results from a prospective interventional case series. Graefe's Arch Clin Exp Ophthalmol 2013;251(10):2403–2413. DOI: 10.1007/s00417-013-2428-y
  17. Blick SKA, Keating GM, Wagstaff AJ. Ranibizumab. Drugs 2007;67(8):1199–1206. DOI: 10.2165/00003495-200767080-00007
  18. Tang M, Yang F, Wang Y, et al. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma glaucoma. BMC Ophthalmol 2016;16(1). DOI: 10.1186/s12886-016-0183-7
  19. Liu L, Xu Y, Huang Z, et al. Intravitreal ranibizumab injection combined trabeculectomy versus Ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications. BMC Ophthalmol 2016;16:65. DOI: 10.1186/s12886-016-0248-7
  20. Coats G. Further cases of thrombosis of the central vein. Roy L Ophthal Hosp Rep. 1906;16.
  21. Mishra A, Luthra S, Baranwal VK, et al. An interesting case of rubeosis iridis with neovascular glaucoma in a young patient. Med J Armed Forces India 2013;69:187–189. DOI: 10.1016/j.mjafi.2012.03.006
  22. Sevim M, Buttanri I, Kugu S. Effect of intravitreal bevacizumab Injection before Ahmed glaucoma valve implantation in neovascular glaucoma. Ophthalmologica 2013;229(2):94–100. DOI: 10.1159/000345490
  23. Xie Z, Liu H, Du M, et al. Efficacy of Ahmed glaucoma valve implantation on neovascular glaucoma. Int J Med Sci 2019;16(10):1371–1376. DOI: 10.7150/ijms.35267
  24. Chalam K V, Gupta SK, Grover S, et al. Intracameral avastin dramatically resolves iris neovascularization and reverses neovascular glaucoma. Eur J Ophthalmol 2008;18(2):255–262. DOI: 10.1177/112067210801800214
  25. Eid TM, Radwan A, El-Manawy W, et al. Intravitreal bevacizumab and aqueous shunting surgery for neovascular glaucoma: safety and efficacy. Can J Ophthalmol 2009;44(4):451–456. DOI: 10.3129/i09–108
  26. Ma KT, Yang JY, Kim H, et al. Surgical results of Ahmed valve implantation with intraoperative bevacizumab injection in patients with neovascular glaucoma. J Glaucoma 2012;21(5):331–336. DOI: 10.1097/IJG.0b013e31820e2fd0
  27. Kang JY, Nam KY, Lee SJ, et al. The effect of intravitreal bevacizumab injection before Ahmed valve implantation in patients with neovascular glaucoma. Int Ophthalmol 2014;34(4):793–799. DOI:10.1007/s10792-013-9875-7
  28. Tailor R, Kinsella MT, Clarke JC, et al. Long-term outcome of intravitreal bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma long-term outcome of intravitreal bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma. Semin Ophthalmol 2018;33(5):606-612. DOI: 10.1080/08820538.2017.1375123
  29. Kwon J, Sung KR. Effect of preoperative intravitreal bevacizumab on the surgical outcome of neovascular glaucoma at different stages. Hindawi J Ophthalmol 2017;2017:7672485. DOI:10.1155/2017/7672485
  30. Sahyoun M, Azar G, Khoueir Z, et al. Long-term results of Ahmed glaucoma valve in association with intravitreal bevacizumab in neovascular glaucoma. J Glaucoma 2015;24(5):383–388. DOI: 10.1097/IJG.0000000000000234
  31. Zhou M, Xu X, Zhang X, et al. Clinical outcomes of Ahmed glaucoma valve implantation with or without intravitreal bevacizumab pretreatment for neovascular glaucoma: a systematic review and meta-analysis. J Glaucoma. 2016;25(7):551–557. DOI: 10.1097/IJG.0000000000000241
  32. Sun Y, Liang Y, Zhou P, et al. Anti-VEGF treatment is the key strategy for neovascular glaucoma management in the short term. BMC Ophthalmol 2016;16(1). DOI: 10.1186/s12886-016-0327-9
  33. Arcieri ES, Paula JS, Jorge R, et al. Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing Ahmed glaucoma valve implantation: 2-year follow-up. Acta Ophthalmol 2015;93(1):e1-6. DOI: 10.1111/aos.12493
  34. Mahdy RA, Nada WM, Fawzy KM, et al. Efficacy of intravitreal bevacizumab with panretinal photocoagulation followed by Ahmed valve implantation in neovascular glaucoma. J Glaucoma 2013;22(9):768–772. DOI: 10.1097/IJG.0b013e318259aec4
  35. Hwang HB, Han JW, Yim HB, et al. Beneficial effects of adjuvant intravitreal bevacizumab injection on outcomes of Ahmed glaucoma valve implantation in patients with neovascular glaucoma: systematic literature review. J Ocul Pharmacol Ther 2015;31(4):198-203. DOI: 10.1089/jop.2014.0108
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