Aflibercept as Adjunctive Treatment for Filtration Surgery in Neovascular Glaucoma

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Naris Kitnarong
Janyawassamon Kittipiriyakul
Anuwat Jiravarnsirikul


Objective: To investigate intravitreal aflibercept (IVA) injection as an adjunctive treatment to trabeculectomy with mitomycin C (TMC) and panretinal photocoagulation (PRP) for neovascular glaucoma (NVG).
Materials and Methods: PRP and IVA (2 mg/0.05 ml) injection were given, and TMC was performed within 2
weeks after IVA. Additional PRP, laser suture lysis, subconjunctival 5-fluorouracil injection, and bleb needling
were performed after TMC if indicated. Best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical
complications, and number of anti-glaucoma medications were collected.
Results: Five eyes from 5 consecutive patients were included. Two eyes had proliferative diabetic retinopathy (PDR), 2 central retinal vein occlusion, and 1 ocular ischemic syndrome (OIS) (mean initial IOP: 46.8±6.8 mmHg). NVI regression occurred in one eye after PRP alone, and in one eye after PRP and IVA resulting in a good IOP control with topical medical therapy. The other 3 underwent TMC. The preoperative IOP was 34 (OIS), 54 (PDR), and 50 (PDR) mmHg. The 3-month postoperative IOP decreased to 8, 8, and 4 mmHg, respectively, and to 21, 10, and 6 mmHg, respectively, at the last visit. Only the one OIS eye required postoperative topical IOP-lowering medications. Final BCVA was improved, unchanged, and decreased in 2, 2, and 1 eye, respectively. No intraoperative/postoperative complications or NVI recurrence were observed (mean follow-up: 10.7 months).
Conclusion: Intravitreal aflibercept was shown to be a potentially effective additional treatment to PRP and TMC in patients with NVG.


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Kitnarong, N. ., Kittipiriyakul, J. ., & Jiravarnsirikul, A. (2022). Aflibercept as Adjunctive Treatment for Filtration Surgery in Neovascular Glaucoma. Siriraj Medical Journal, 74(1), 27–33.
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