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Results of intracameral bevacizumab injection in rubeosis iridis due to neovascular glaucoma

Poster Details

First Author: A.Rashed EGYPT

Co Author(s):                  

Abstract Details



Purpose:

1. Asses the efficacy of intracameral bevacizumab to decrease the amount of anterior segment neovascularization evident on Iris Fluorescein Angiography (IFA). 2. Monitor the effect with IFA. 3. Evaluate the corneal endothelium by specular microscopy before and after injection.

Setting:

Opthalmology Department,Cairo University.

Methods:

Twenty five eyes of 25 consecutive patients with rubeosis iridis secondary to neovascular glaucoma (NVG)were referred to Ophthalmology Department in Cairo University, were recruited in this prospective study.Patients' ages ranged from 25 to 65 years with a mean of 45.6 years. Thirteen of the patients were males and the remaining 12 were females. Of the 25 NVG cases included in this study, 12 were secondary to diabetic retinopathy, 11 were due to central retinal vein occlusion, 1 was due chemical injury, and the remaining 1 was following retinal detachment surgery. The best corrected visual acuity was ranging from 6/18 to hand motion. The follow-up period spanned from 1 week to 6 months. Treatment was scheduled between 1 and 4 days after initial iris flourescein angiography and specular microscopy. The procedure was done in a surgical ward after instillation of topical anaesthetic drops, disinfection, sterile draping and lid speculum application. Limbal paracentesis was performed by an insulin syringe, then injection of 1mg (0.04ml) of Bevacizumab(Avastin) into the anterior chamber, followed by prescription of oral acetazolamide 500mg tablets immediately after the procedure.

Results:

The first criterion evaluated in our study was the regression of neovascularization. It showed marked regression during the first week of follow up. Then the regression effect started to deteriorate over the next one month follow up and showed almost complete return of neovascularization in the last two follow up periods; 3 and 6 months. The second criterion evaluated in our study was endothelial cell count. It showed no marked drop in count during the whole follow up periods . Regarding the first correlation, the IOP, it was consistently lower after injection during the whole follow up period (P=0.05). The other correlation was the best corrected visual acuity (BCVA) which was assessed by Landolt's chart then converted to logMAR. It showed a decrease in BCVA over time, which was not statistically significant (P=0.13).

Conclusions:

Although bevacizumab is showing a promising strategy as adjunctive treatment of anterior segment neovascularization and NVG ,however; there is still a need for controlled prospective trials to establish long-term safety, efficacy, and dosing guidelines in retinal ischemia and NVG. FINANCIAL INTEREST: NONE

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