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Combined cataract and neovascular glaucoma surgery with Ex-PRESS™ glaucoma filtration device in conjunction with bevacizumab

Poster Details

First Author: V.Serdjuk UKRAINE

Co Author(s):    S. Ustimenko   V. Ishchenko   L. Bereznjuk        

Abstract Details



Purpose:

To test the EX-PRESS™ Glaucoma Filtration Device (GFD) in conjunction with Bevacizumab in patients with visually significant comlicated cataract and uncontrolled neovascular glaucoma (NVG) due to proliferative diabetic retinopathy (PDR)

Setting:

Dnepropetrovsk regional clinical ophthalmologic hospital

Methods:

Methods: A prospective non–randomized pilot study was performed on 14 eyes of fourteen patients with NVG due to PDR. Injection of bevacizumab (1.25 mg/0.05 mL) was performed under topical anesthesia 1 week befor combined surgery . The surgery consisted of performing microcoaxial phacoemulsification with IOL implantation and implantation of the ExPRESS GFD, under a 6x5mm scleral flap. Mitomycin C 0.2% solution was applied on the area of deep sclerectomy under the scleral flap for 3 minutes prior to the insertion of the ExPRESS shunt. Outcome measures included intra–ocular pressure (IOP), visual acuity , number of anti–glaucoma medications and complications.

Results:

preoperatively VA was from light perception to 0.01 sc. after one year follow up VA was 0,02-0,05 sc in 6 patients (43%), 0,05-0,1 sc in 5 patients (36%), 0,1-0,4sc in 3 patients( 21%). The overall mean (ḟSD) IOP preoperatively was 46.7 mmHg (ḟ4.5). One year post–operatively The operation was successful (IOP 21 mmHg , the overall mean IOP was 18.2 mmHg (ḟ2.7) without antiglaucoma medications) in ten of fourteen cases ( 86 %) Pre–operatively all the patients used anti–glaucoma medications. At one year, ten patients were not using anti–glaucoma medications. In two patients IOP was uncontrolled due to bleb fibrosis . These patiens needed bleb revision to remove scar tissue. 5 ( 36%) patients required repeated injections of bevacizumab due to recurrent iris neovascularisation. . There were no episodes of post–operative hypotony.

Conclusions:

Implantation of Ex-Press GFD made it possible to achieve stable IOP in 86% of patients. Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an ExPRESS GFD and perform cataract surgery in NVG . In our opinion implantation of Ex-Press devise should be performed at early stages of NVG.

Financial Disclosure:

NONE

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