Naris Kitnarong

Surgical outcome of intravitreal bevacizumab and filtration surgery in neovascular glaucoma

IntroductionThe purpose of this study was to evaluate the surgical outcome of a trabeculectomy with mitomycin C (MMC) in neovascular glaucoma after an adjunctive treatment with intravitreal bevacizumab (Avastin®; Genentech Inc, San Francisco, CA, USA) injection (IVB).MethodsSix patients with NVG presented at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. After adequate panretinal photocoagulation (PRP) and maximal antiglaucoma medication therapy, these patients received IVB (1.25 mg in 0.05 ml) due to persistent neovascularisation of the iris (NVI). A fornix-based conjunctival flap trabeculectomy with MMC was performed within 4 weeks following administration of IVB.ResultsThree patients with proliferative diabetic retinopathy (PDR) and three patients with central retinal vein occlusion (CRVO) were enrolled in the study (mean age, 57 years). Absolute regression of NVI was observed within 1 week after IVB in four patients. In two patients NVI was reduced but still persisted. Mean intraocular pressure (IOP) decreased from 39.8 mmHg pre-operatively to 7.5 mmHg on the first postoperative day. No intra-operative complications were noted. Two patients had postoperative hyphema, which resolved spontaneously within 1 week. During the mean follow up of 24.7 weeks, five patients had controlled IOP (range, 2–16 mmHg) without antiglaucoma medication. Two patients with PDR had improved visual acuity whereas two patients with CRVO lost pre-operative light perception. Recurrent NVI was subsequently detected in one patient who had uncontrolled IOP. This patient underwent transscleral diode laser cyclophotocoagulation and additional PRP. All patients were symptom-free at last visit.ConclusionIVB is an effective modality to reduce intra-operative complications during trabeculectomy for neovascular glaucoma. The short-term outcomes following trabeculectomy with MMC are favourable.

Immediate Anterior Chamber Paracentesis with a 30-Gauge Needle for Acute Primary Angle Closure

Background: Primary angle-closure glaucoma (PACG) is more common among Asians than among Caucasians. Acute primary angle closure (APAC) is a serious associated complication in PACG patients. When conventional treatment fails, Anterior Chamber Paracentesis (ACP) can be performed to decrease IOP. Although slit knives are commonly used for performing ACP, other techniques can also be used to perform this procedure. Objective: To investigate the efficacy and safety of immediate anterior chamber paracentesis using a 30-gauge needle combined with conventional topical and systemic medications for the treatment of APAC. Materials and methods: This prospective study was conducted in 15 consecutive primary angle-closure glaucoma patients that presented with and who were treated for acute primary angle closure (APAC) at the Department of Ophthalmology, Siriraj Hospital, (Bangkok, Thailand) during the January 2015 to December 2015 study period. Patients were included if they were older than 18 years of age, if this was their first known attack of APAC, and if they had an IOP ≥ 40 mmHg. Results: Mean age of the 15 included participants (3 males, 12 females) was 61 years. Mean presenting IOP ± SD was 54.3 ± 11.6 mmHg. Twelve of 15 eyes had visual acuity worse than 6/18. Immediately after ACP, mean IOP ± SD was 7.5 ± 5.1 mmHg. None of the 15 included eyes were reactive to light prior to ACP. Mean pupil diameter was significantly reduced from baseline at 60 minutes after ACP (p=0.004) and was significantly smaller than baseline at 24 h after ACP (p=0.03). BCVA was improved to ≥ 6/18 in 11 and 12 eyes at 1 and 24 h after ACP, respectively. All patients had relief from symptoms immediately following ACP. No ACP-related complications were observed in any patient in this study. Conclusion: Immediate APC with a 30-guage needle is a safe and effective initial treatment for APAC. APC should be combined with conventional treatment with topical and/or systemic medications. APC yields rapid IOP reduction, dramatic relief of symptoms, and corneal clarity. APC may also improve response to further treatment, improve IOP control, and may reduce or eliminate the need for systemic medication.