Posters

Does intravitreal injection of bevacizumab reduce the incidence of neovascular glaucoma following ischaemic CRVO: a study

Poster Details

First Author: H.Amin INDIA

Co Author(s):    N. Borah   S. Ahmed           

Abstract Details

Purpose:

to study whether early and repeated intravitreal injections of bevacizumab reduces the incidence of development of NVG following ischaemic CRVO.

Setting:

a retrospective analysis of 66 eyes (64 patients) with ischaemic CRVO who had reported to our institutes at Guwahati eye institute and research center ,Guwahati and K.S Hegde medical academy Mangalore within 1 month of development of the disease . Period of study: August, 2007 to July, 2013.

Methods:

Following ischaemic central retinal vein occlusion(CRVO) possibilities of developing neovascular glaucoma(NVG) greatly increase. Treatment of NVG is not satisfactory specially in closed angle stage. After introduction of intravitreal injection of anti VEGF (bevacizumab or ranibizumab) the management of neovascular glaucoma has improved. We wanted to investigate whether following development of ischaemic CRVO, early and repeated intravitreal injections of bevacizumab reduces the likelihood of development of NVG compared to no treatment/observation over a period of 18 months follow up. a retrospective analysis of 66 eyes (64 patients) with ischaemic CRVO who had reported to our institute within 1 month of development of the disease . Period of study: August, 2007 to July, 2013. BCVA, IOT, gonioscopy, Slit lamp and fundus examinations were routinely done. FFA and OCT were done whenever necessary. Patients were divided into two groups. In group A, 36 eyes (34 patients) received intravitreal bevacizumab (avastin, 0.05 ml) monthly for three consecutive months and then every 2 monthly after anterior and posterior segment examinations. In group B, 30 eyes(30 patients) were kept as controls. The patients who refused treatment with intravitreal injection of bevacizumab or the injection was contraindicated were kept in group B and observed. All the patients were followed for a period of 18 months(n=64). Upon detection of NVG prompt treatment was instituted (PRP, anti VEGF assisted Trab + MMC, anti glaucoma medications, cyclocryopexy).

Results:

14 eyes (38.9%) in group A and 17 eyes (56.7%) in group B developed NVG following ischaemic CRVO over a period of 18 months follow up. (P value = 0.149). 2.78% eyes in group A and 26.7% eyes in group B had developed NVG within 9 months of ischaemic CRVO. 7 eyes in group A and 11 eyes in group B had to be managed with combination treatment of PRP, anti VEGF assisted Trab + MMC, anti glaucoma medications, cyclocryopexy (after clinical evaluation). Average IOT at 18 month follow up in group A was 26.1mm Hg and in Group B was 32.3mm Hg. 3 eyes in group A and 9 eyes in group B had PL - ve vision at the end of 18 month follow up. Average 10 intravitreal injection/eye were needed in 18 months in group A.

Conclusions:

NVG is a dreaded complication which may develop following ischaemic CRVO. Intravitreal injections of bevacizumab could delay or reduce development of NVG following ischaemic CRVO (14 eyes in Group A and 17 eyes in Group B at 18 months). Close follow up and prompt treatment with PRP, Trab + MMC, anti glaucoma medication, cyclocryopexy may be is necessary (once NVG develops) even following repeated intravitreal bevacizumab injections. With anti VEGF treatment (bevacizumab) IOT could be controlled and visual acuity can be salvaged/preserved till release of VEGF from ischaemic retina decrease/stops spontaneously. FINANCIAL INTEREST: NONE