Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study
DOI:
https://doi.org/10.13181/mji.v28i3.2865Keywords:
Ahmed glaucoma valve, bevacizumab, intraocular pressure, neovascularization, photocoagulation, vascular endothelial growth factorAbstract
BACKGROUND The aim of this study was to determine the levels of vascular endothelial growth factor (VEGF) in the aqueous humor and the effect of intravitreal anti-VEGF injection combined with panretinal photocoagulation (PRP) on the management in diabetes mellitus (DM) patients with neovascular glaucoma (NVG).
METHODS This study was a prospective, interventional study in DM patients with NVG. Paracentesis followed by intravitreal bevacizumab (IVB) injection was performed in all eyes. The concentration of VEGF obtained from paracentesis was measured. In week-1, the intraocular pressure (IOP), sectorial iris neovascularization (NVI), and visual acuity were documented, and management was continued with PRP laser over a period of 1 week. All parameters and additional interventions performed after PRP were also recorded.
RESULTS A total of 18 eyes from 17 patients were studied. The mean (SD) level of VEGF in the aqueous humor was 3,864 (1,468) pg/ml, and the mean (SD) of initial IOP was 39 (10.2) mmHg. There was a significant reduction in IOP in week-1 after the first intervention to 24.4 (8.0) mmHg (p = 0.001); however, at 2 weeks the IOP increased to 30.4 (6.7) mmHg. NVI showed significant regression in week-1 after IVB combined with PRP laser (p < 0.05). All eyes required additional glaucoma implants (14 eyes) and cyclocryotheraphy (4 eyes).
CONCLUSIONS In the eyes of diabetes patients with NVG, VEGF levels were high. With the use of IVB, the IOP was reduced, and NVI regressed; however, due to the severe stages of disease, all eyes required glaucoma surgery.
Downloads
References
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53. https://doi.org/10.2337/diacare.27.5.1047
Aiello LP, Northrup JM, Keyt BA, Takagi H, Iwamoto MA. Hypoxic regulation of vascular endothelial growth factor in retinal cells. Arch Ophthalmol. 1995;113(12):1538-44. https://doi.org/10.1001/archopht.1995.01100120068012
Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994;331(22):1480-7. https://doi.org/10.1056/NEJM199412013312203
Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev. 2004;25(4):581-611. https://doi.org/10.1210/er.2003-0027
Davidorf FH, Mouser JG, Derick RJ. Rapid improvement of rubeosis iridis from a single bevacizumab (Avastin) injection. Retina. 2006;26(3):354-6. https://doi.org/10.1097/00006982-200603000-00017
Malik RA, Li C, Aziz W, Olson JA, Vohra A, McHardy KC, et al. Elevated plasma CD105 and vitreous VEGF levels in diabetic retinopathy. J Cell Mol Med. 2005;9(3):692-7. https://doi.org/10.1111/j.1582-4934.2005.tb00499.x
Rodrigues GB, Abe RY, Zangalli C, Sodre SL, Donini FA, Costa DC, et al. Neovascular glaucoma: a review. Int J Retin Vitr. 2016;2:26. https://doi.org/10.1186/s40942-016-0051-x
Al-Bahlal A, Khandekar R, Al Rubaie K, Alzahim T, Edward DP, Kozak I. Changing epidemiology of neovascular glaucoma from 2002 to 2012 at King Khaled Eye Specialist Hospital, Saudi Arabia. Indian J Ophthalmol. 2017;65(10):969-73. https://doi.org/10.4103/ijo.IJO_33_17
Hayreh SS. Neovascular glaucoma. Prog Retin Eye Res. 2007;26(5):470-85. https://doi.org/10.1016/j.preteyeres.2007.06.001
Lazcano-Gomez G, R Soohoo J, Lynch A, N Bonell L, Martinez K, Turati M, et al. Neovascular glaucoma: a retrospective review from a Tertiary Eye Care Center in Mexico. J Curr Glaucoma Pract. 2017;11(2):48-51. https://doi.org/10.5005/jp-journals-10028-1222
Tripathi RC, Li J, Tripathi BJ, Chalam KV, Adamis AP. Increased level of vascular endothelial growth factor in aqueous humor of patients with neovascular glaucoma. Ophthalmology. 1998;105(2):232-7. https://doi.org/10.1016/S0161-6420(98)92782-8
Reina-Torres E, Wen JC, Liu KC, Li G, Sherwood JM, Chang JYH, et al. VEGF as a paracrine regulator of conventional outflow facility. Invest Ophthalmol Vis Sci. 2017;58(3):1899-908. https://doi.org/10.1167/iovs.16-20779
Venkat A, Singh R, Eisengart J, Ming H, Ehlers J, Babiuch A. Neovascular glaucoma management: practice patterns of glaucoma and retina specialists in the United States. Invest Ophthalmol Vis Sci. 2017;58(8):3668.
SooHoo JR, Seibold LK, Kahook MY. Recent advances in the management of neovascular glaucoma. Semin Ophthalmol. 2013;28(3):165-72. https://doi.org/10.3109/08820538.2012.730103
Simha A, Braganza A, Abraham L, Samuel P, Lindsley K. Antivascular endothelial growth factor for neovascular glaucoma. Cochrane Database Syst Rev. 2013;(10):CD007920. https://doi.org/10.1002/14651858.CD007920.pub2
Allingham R, Damji K, Freedman S, Moroi S, Shafranov G. Shields Textbook of Glaucoma 5th Edition. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 27-512.
Sun Y, Liang Y, Zhou P, Wu H, Hou X, Ren Z, et al. Anti-VEGF treatment is the key strategy for neovascular glaucoma management in the short term. BMC Ophthalmol. 2016;16(1):150. https://doi.org/10.1186/s12886-016-0327-9
Olmos LC, Lee RK. Medical and surgical treatment of neovascular glaucoma. Int Ophthalmol Clin. 2011;51(3):27-36. https://doi.org/10.1097/IIO.0b013e31821e5960
Higashide T, Ohkubo S, Sugiyama K. Long-term outcomes and prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma. PLoS One. 2015;10(8):e0135766. https://doi.org/10.1371/journal.pone.0135766
Campochiaro PA, Aiello LP, Rosenfeld PJ. Anti-vascular endothelial growth factor agents in the treatment of retinal disease: from bench to bedside. Ophthalmology. 2016;123(10S):S78-88. https://doi.org/10.1016/j.ophtha.2016.04.056
Costagliola C, Cipollone U, Rinaldi M, della Corte M, Semeraro F, Romano MR. Intravitreal bevacizumab (Avastin®) injection for neovascular glaucoma: a survey on 23 cases throughout 12-month follow-up. Br J Clin Pharmacol. 2008;66(5):667-73. https://doi.org/10.1111/j.1365-2125.2008.03278.x
Wu L, Martinez-Castellanos MA, Quiroz-Mercado H, Arevalo JF, Berrocal MH, Farah ME, et al. Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol. 2008;246(1):81-7. https://doi.org/10.1007/s00417-007-0660-z
Ichhpujani P, Ramasubramanian A, Kaushik S, Pandav SS. Bevacizumab in glaucoma: a review. Can J Ophthalmol. 2007;42(6):812-5. https://doi.org/10.3129/i07-160
Beutel J, Peters S, Luke M, Aisenbrey S, Szurman P, Spitzer MS, et al. Bevacizumab as adjuvant for neovascular glaucoma. Acta Ophthalmol. 2010;88(1):103-9. https://doi.org/10.1111/j.1755-3768.2008.01355.x
Matsuyama K, Ogata N, Jo N, Shima C, Matsuoka M, Matsumura M. Levels of vascular endothelial growth factor and pigment epithelium-derived factor in eyes before and after intravitreal injection of bevacizumab. Jpn J Ophthalmol. 2009;53(3):243-8. https://doi.org/10.1007/s10384-008-0645-4
Lim TH, Bae SH, Cho YJ, Lee JH, Kim HK, Sohn YH. Concentration of vascular endothelial growth factor after intracameral bevacizumab injection in eyes with neovascular glaucoma. Korean J Ophthalmol. 2009;23(3):188-92. https://doi.org/10.3341/kjo.2009.23.3.188
Blum A, Socea D, Ben-Shushan RS, Keinan-Boker L, Naftali M, Segol G, et al. A decrease in VEGF and inflammatory markers is associated with diabetic proliferative retinopathy. Eur Cytokine Netw. 2012;23(4):158-62. https://doi.org/10.1684/ecn.2012.0321
Li ZQ, Zhou XX, Lin S, Li JL, Wu JG. Angiography reveals early hiding iris neovascularization after ischemic CRVO. Int J Ophthalmol. 2013;6(2):253-4. http://doi.org/10.3980/j.issn.2222-3959.2013.02.28
Tang M, Fu Y, Wang Y, Zheng Z, Fan Y, Sun X, et al. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment of neovascular glaucoma. BMC Ophthalmol. 2016;16:7. https://doi.org/10.1186/s12886-016-0183-7
Kernt M, Neubauer AS, Kampik A. Intravitreal bevacizumab (Avastin) treatment is safe in terms of intraocular and blood pressure. Acta Ophthalmol Scand. 2007;85(1):119-20. https://doi.org/10.1111/j.1600-0420.2006.00819.x
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
