REMOTE RESULTS OF THE NEW NEOVASCULAR GLAUCOMA COMBINATION TREATMENT METHOD: SINUSTRABECULECTOMY WITH SILICONE DRAINAGE IMPLANTATION AFTER INTRAVITREAL BEVACIZUMAB (AVASTIN) INJECTION
Purpose. To evaluate the efficacy of a new combined treatment method for neovascular glaucoma. Methods. The combined method consists of two sequential steps: first - intravitreal bevacizumab (1.25 mg) injection according to the standard protochol, second - in 5-7 days after injection - sinustrabeculectomy with anterior chamber silicon drainage implantation. 48 eyes (42 patients) with neovascular glaucoma of different etiologies were enrolled in this study. The follow-up period was 12 months. Results. Intraocular pressure decrease (up to no more than 22 mm-g) during 12 months of follow-up was achieved in 95.8 % of cases; in 85.4 % - without any additional therapy. No cases of hypotony or phthisis bulbi were reported. Visual acuity after 12 months was preserved in 37 cases (77.1 %). In the late post-op period (6-12 months), 7 cases (14.6%) showed signs of excessive scarring in the bleb area, but no case needed revision or drainage reposition. Even in the cases of observed scarring, in the majority cases the IOP was 18-22 mm Hg (with additional hypotensive monotherapy). During the followup, no relapses of anterior segment neovascularization were reported. Conclusion. Pre-surgical intravitreal bevacizumab (1.25 mg) injection reduces the risk of intraoperative complications during sinustrabeculectomy with anterior chamber drainage implantation, and also during the early post-op in neovascular glaucoma patients. Study results indicate that this new combined method of management of neovascular glaucoma allows fast and effectively decrease of IOP, and preserves visual function during the 12 months postoperative follow-up.