Transcript The early hypotony protection effect of intraoperative

Two Cases of Subconjunctival Bevacizumab Injection
to
Prevent Bleb Failure after Trabeculectomy
Dongwook Lee, Min Ahn, In-Cheon You, Daegyu Lee
Chonbuk National University Medical School, Korea
Authors have no financial interests in this presentation
Purpose
• Angiogenesis plays a important role in wound healing
process, but it is an unwanted process after
trabeculectomy.
• Bleb failure involves vascularization with fibroblast
migration and scarring of the fistula tract.
• Vascular Endothelial Growth Factor (VEGF) is a unique
mitogen specific to vascular endothelial cells and the
signal cascade leading to fibroblast migration and
proliferation involves dynamic interaction between many
cytokines.
Purpose
• Blocking the neovascular signal cascade with anti-VEGF
molecules like Bevacizumab may lead to a decrease in
fibroblast proliferation by decreasing the supply of
mitogenic cytokines such as fibroblast growth factor (FGF)
carried in by new vessel formation
• We analyze the safety and efficacy of Subconjunctival
Injection of bevacizumab (Avastin) for preventing bleb
failure following trabeculectomy
Method
• The clinical interventional case study included 2 patients with
inflammatory glaucoma (Posner-Schlossman syndrome and
Bechet’s disease)
• Limbal based standard trabeculectomy was performed without
mitomycin-C treatment.
• Subconjunctival bevacizumab injections (1.25 ㎎/0.05 ㎖) was
given at the end of the surgery adjacent to the bleb raised using
a single-use 26 gauge needle and syringe.
Method
•
Patients characteristics
case
Age/sex
Diagnosis
Pre-operative
IOP
Pre–operative
BCVA *
1
37/M
Posner-schlossman
syndrome
40 mmHg
0.15
2
28/M
Behcet disease
28 mmHg
0.1
Results
• Case 1
– A 37 years old male with Posner-Schlossman syndrome on his
right eye
– Uncontrolled intraocular pressure (around 40mmHg) with the
maximum glaucoma medications and steroid (40 mg/day)
administration.
– Visual field defect (MD, -14dB) and disc cupping
– Trabeculectomy with Subconjunctival bevacizumab injections
– Post operative 2nd week, additional bevacizumab (1.25 mg/0.05
㎖) injection under a slit lamp because of intense uveitis and
increase vascular congestion and vascularization
Results
• Case 2
– a 28 year old male suffering from Bechet’s disease
and uveitis in both eyes
– about 50% peripheral anterior synechiae of iris
through a gonioscopy, and glaucoma-induced
changes in optic discs which had a decreased
sensitivity of -10 dB in the visual field test
– Trabeculectomy with Subconjunctival bevacizumab
injections
Case 1 patient
(1a) Single layer of limbus- based flap and subconjunctival
Bevacizumab injection.
(1b) Post-operation 1 month photography. Note conjunctival
injection and ketatic precipitates on lower half cornea due to iridocyclitis
but bleb area shows no vascularization.
Case 2 patient
(2a) Post-operation 1 day photography.
(2b) 3 months after trabeculectomy with subconjunctival Bevacizumab
injection. Note the well functioning bleb.
CASE 1
CASE 2
45
40
IOP (mmHg)
35
30
25
20
15
10
5
0
Preop
1 week
2 weeks
1 month
3 months
6 months
Intraocular pressure(IOP) changes following trabeculectomy with
subconjunctival Bevacizumab injection.
Conclusion
• The clinical interventional study included 2 patients
with secondary glaucoma associated with uveitis
• Subconjunctival bevacizumab to prevent bleb failure
after trabeculectomy show good results
• No adverse incidents were observed