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First Author: V.Serdjuk UKRAINE
Co Author(s): S. Ustimenko V. Ishchenko L. Bereznjuk
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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)
Dnepropetrovsk regional clinical ophthalmologic hospital
Methods: A prospective nonrandomized 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 intraocular pressure (IOP), visual acuity , number of antiglaucoma medications and complications.
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 postoperatively 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 %) Preoperatively all the patients used antiglaucoma medications. At one year, ten patients were not using antiglaucoma 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 postoperative hypotony.
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.