PURPOSE: To describe the outcomes of combining diode laser cyclophotocoagulation and intravitreal Bevacizumab (Avastin) in comparison to diode laser cyclophotocoagulation for managment of Neovascular glaucoma.
PATIENTS AND METHODS: Forty two eyes of 42 patients were included in this study and divided into two groups, each group contains 21 eyes. One group was treated with Diode Laser cyclophotocoagulation and Intravitreal Bevacizumab (Avastin), and the other group was treated with Diode Laser cyclophotocoagulation between July 2006 through July 2007 . Preoperative and postoperative intraocular pressure, number of glaucoma medications, vision, and complications data were collected for each eye.
RESULTS: A total of 42 eyes of 42 patients met the study criteria. The minimum follow-up period after the last surgery was 6 months. Intraocular pressures were reduced from 46.5 +/- 7.2 mm Hg preoperatively to 22.9 +/- 5.4 mm Hg postoperatively at 6 months (P < 0.000, n = 9) in 21 eyes treated with diode laser cyclophotocoagulation and intravitreal Bevacizumab (Avastin) in comparison to reduction of IOP from 46.5 +/- 7.2 mm Hg preoperatively to 28.6 +/- 4.2 mm Hg in 21 eyes treated with diode laser cyclophotocoagulation . Medications were reduced from 2.7 +/- 1.2 preoperatively to 0.3 +/- 0.5 postoperatively at 6 months (P < 0.000, n = 9). Of the eyes with measurable Snellen acuity, postoperative vision decreased two or more lines in five eyes (63%). Complications included transient hypotony (one eye), transient serous choroidal detachment (two eyes), cystoid macular edema (two eyes), corneal edema (three eyes), panuveitis with chronic hypotony and traction retinal detachment (one eye), and Combined hyphema/vitreous hemorrhage (one eye ) .
CONCLUSIONS: Combining diode laser cyclophotocoagulation with intravitreal Bevacizumab (Avastin) can effectively reduce intraocular pressure and reduce number of glaucoma medications and resolve rubeosis iridis to achieve target intraocular pressure goals more than diode laser cyclophotocoagulation. Further study is needed to determine the safety of this combined approach compared with other available options to manage Neovascular glaucoma
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