Aflibercept as Adjunctive Treatment for Filtration Surgery in Neovascular Glaucoma

Naris  Kitnarong; Janyawassamon  Kittipiriyakul; Anuwat Jiravarnsirikul

doi:10.33192/Smj.2022.4

Authors

Naris Kitnarong Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Janyawassamon Kittipiriyakul Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Anuwat Jiravarnsirikul Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/Smj.2022.4

Keywords:

Aflibercept, adjunctive treatment, filtration surgery, neovascular glaucoma

Abstract

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.

References

Brown GC, Magargal LE, Schachat A, Shah H. Neovascular glaucoma. Etiologic considerations. Ophthalmology. 1984;91(4): 315-20.

Sivak-Callcott JA, O’Day DM, Gass JD, Tsai JC. Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology. 2001;108(10):1767-76; quiz77,800.

Rodrigues GB, Abe RY, Zangalli C, Sodre SL, Donini FA, CostaDC, et al. Neovascular glaucoma: a review. Int J Retina Vitreous. 2016;2:26.

Kim M, Lee C, Payne R, Yue BY, Chang JH, Ying H. Angiogenesis in glaucoma filtration surgery and neovascular glaucoma: A review. Surv Ophthalmol. 2015;60(6):524-35.

Hayreh SS. Neovascular glaucoma. Prog Retin Eye Res. 2007;26(5):470-85.

Moraczewski AL, Lee RK, Palmberg PF, Rosenfeld PJ, Feuer WJ. Outcomes of treatment of neovascular glaucoma with intravitreal bevacizumab. Br J Ophthalmol. 2009;93(5):589-93.

Yazdani S, Hendi K, Pakravan M, Mahdavi M, Yaseri M. Intravitreal bevacizumab for neovascular glaucoma: a randomized controlled trial. J Glaucoma. 2009;18(8):632-7.

Kobayashi S, Inoue M, Yamane S, Sakamaki K, Arakawa A, Kadonosono K. Long-term Outcomes After Preoperative Intravitreal Injection of Bevacizumab Before Trabeculectomy for Neovascular Glaucoma. J Glaucoma. 2016;25(3):281-4.

Alkawas AA, Shahien EA, Hussein AM. Management of neovascular glaucoma with panretinal photocoagulation, intravitreal bevacizumab, and subsequent trabeculectomy with mitomycin C. J Glaucoma. 2010;19(9):622-6.

Kitnarong N, Chindasub P, Metheetrairut A. Surgical outcome of intravitreal bevacizumab and filtration surgery in neovascular glaucoma. Adv Ther. 2008;25(5):438-43.

Kitnarong N, Sriyakul C, Chinwattanakul S. A Prospective Study to Evaluate Intravitreous Ranibizumab as Adjunctive Treatment for Trabeculectomy in Neovascular Glaucoma. Ophthalmol Ther. 2015;4(1):33-41.

Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119(12): 2537-48.

Ohr M, Kaiser PK. Aflibercept in wet age-related macular degeneration: a perspective review. Ther Adv Chronic Dis. 2012;3(4):153-61.

Iliev ME, Domig D, Wolf-Schnurrbursch U, Wolf S, Sarra GM. Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma. Am J Ophthalmol. 2006;142(6):1054-6.

Vatavuk Z, Bencic G, Mandic Z. Intravitreal bevacizumab for neovascular glaucoma following central retinal artery occlusion. Eur J Ophthalmol. 2007;17(2):269-71.

Olmos LC, Sayed MS, Moraczewski AL, Gedde SJ, Rosenfeld PJ, Shi W, et al. Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab. Eye (Lond). 2016;30(3):463-72.

Marshall JL. Bevacizumab in the treatment of colorectal cancer. Clin Adv Hematol Oncol. 2007;5(1 Suppl 1):8-9.

Caprioni F, Fornarini G. Bevacizumab in the treatment of metastatic colorectal cancer. Future Oncol. 2007;3(2):141-8.

Horsley MB, Kahook MY. Anti-VEGF therapy for glaucoma. Curr Opin Ophthalmol. 2010;21(2):112-7.

Luke J, Nassar K, Luke M, Grisanti S. Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma--results from a prospective interventional case series. Graefes Arch Clin Exp Ophthalmol. 2013;251(10):2403-13.

Gillies MC, Campain A, Walton R, Simpson JM, Arnold JJ, Guymer RH, et al. Time to Initial Clinician-Reported Inactivation of Neovascular Age-Related Macular Degeneration Treated Primarily with Ranibizumab. Ophthalmology. 2015;122(3):589-94 e1.

Ashraf M, Souka AAR. Aflibercept in age-related macular degeneration: evaluating its role as a primary therapeutic option. Eye (Lond). 2017;31(11):1523-36.

Bakall B, Folk JC, Boldt HC, Sohn EH, Stone EM, Russell SR, et al. Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol. 2013;156(1):15-22 e1.

Papadopoulos Z. Aflibercept: A review of its effect on the treatment of exudative age-related macular degeneration. Eur J Ophthalmol. 2019;29(4):368-78.

Lusthaus J, Goldberg I: Current management of glaucoma. Med J Aust 2019, 210(4):180-187.

Sakiyalak D, Hongyok T, Kitnarong N: Sequential versus Combined Glaucoma and Cataract Procedures in Siriraj Hospital. Siriraj Med. J. 2006;58 (7):911-5

Kiuchi Y, Sugimoto R, Nakae K, Saito Y, Ito S. Trabeculectomy with mitomycin C for treatment of neovascular glaucoma in diabetic patients. Ophthalmologica. 2006;220(6):383-8.

Li Z, Van Bergen T, Van de Veire S, Van de Vel I, Moreau H, Dewerchin M, et al. Inhibition of vascular endothelial growth factor reduces scar formation after glaucoma filtration surgery. Invest Ophthalmol Vis Sci. 2009;50(11):5217-25.

O’Neill EC, Qin Q, Van Bergen NJ, Connell PP, Vasudevan S, Coote MA, et al. Antifibrotic activity of bevacizumab on human Tenon’s fibroblasts in vitro. Invest Ophthalmol Vis Sci. 2010; 51(12):6524-32.

Schmucker C, Loke YK, Ehlken C, Agostini HT, Hansen LL, Antes G, et al. Intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) for the treatment of age-related macular degeneration: a safety review. Br J Ophthalmol. 2011;95(3):308-17.

Takihara Y, Inatani M, Kawaji T, Fukushima M, Iwao K, Iwao M, et al. Combined intravitreal bevacizumab and trabeculectomy with mitomycin C versus trabeculectomy with mitomycin C Kitnarong et al.

https://he02.tci-thaijo.org/index.php/sirirajmedj/index Volume 74, No.1: 2022 Siriraj Medical Journal 33

Original Article SMJ alone for neovascular glaucoma. J Glaucoma. 2011;20(3):196-201.

Xu Y, Tan CS. Safety and complications of intravitreal injections performed in an Asian population in Singapore. Int Ophthalmol.2017;37(2):325-32.

Daien V, Nguyen V, Essex RW, Morlet N, Barthelmes D, Gillies MC, et al. Incidence and Outcomes of Infectious and Noninfectious Endophthalmitis after Intravitreal Injections for Age-Related Macular Degeneration. Ophthalmology. 2018;125(1):66-74.

Hoguet A, Chen PP, Junk AK, Mruthyunjaya P, Nouri-Mahdavi K, Radhakrishnan S, et al. The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology. 2019;126(4):611-22.

Bracha P, Moore NA, Ciulla TA, WuDunn D, Cantor LB. The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review. Surv Ophthalmol. 2018;63(3):281-95.