The use of Avastin is justified if a surgery like AGV is planned to reduce intra-op bleeding, but in long term does it effect IOP?
Hi,
We have been treating vitreo-retinal lymphoma patients with intra-vitreal injections of methotrexate for almost 20 years now. We have published that in some patients a neovascular membranes grows over the AC angle producing neovascular glaucoma.
This side effect usually appears when the patients are coming for their monthly MTX injections. We take the IOP on every visit, and if we see an increase in IOP we look at the angle, so we see the NVA almost as soon as it appears.
In this group of patients, if caught and treated early, 1 Avastin I.Vit. injection appears to be enough with long term effects (years).
I am not sure this holds for other etiologies of NVG.
I have not evidence that Avastin or other anti-VEGF could reduce intraocular pressure. The rational for its use is to reduces bleeding duringsurgery, and then to diminish intra and post-operative complications.
in cases of rubeosis, before the closing of the angle, it could be effective in preventing the further development of a neovascular glaucoma. But I have not enough experience in this subject
In neovascular Glaucoma you must treat the ischemic retina if it,s possible, because when you only suppress the VEGF you are not treating the cause, you are only treating part of the problem, and the half live of the antiVEGF is less than a month. When there is medium opacities you can make vitrectomy endolaser, and valve, previous anti VEGF (3 to 7 days), or valve with pan crioterapy, When you have clear media you can make panfotocoagulation and antiVEGF monthly for 3 months, Always think in vasculitis as a cause of occlusive retinal disease, and close angle glaucoma as the main cause of central vein occlusion.
Avastin will cause temporary regression of iris neovascularization. The effect of Avastin on the IOP depends on how long the angle has been closed. I have seen newly diagnosed patients reopen their angle and lower their IOP after treatment with Avastin. Chronic cases with peripheral anterior synechiae will not reopen. Monthly Avastin injections can be used indefinitely if you are unable to perform pan-retinal photocoagulation, but then the neovascularization will probably recur once you stop the injections.