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Good Hope Hospital Eye Clinic

Rubeotic Glaucoma for professionals, some notes
notes from lectures made by David Kinshuck

 


Treatment plan

IVA (Avastin...Bevacizumab)

  • is very effective in reducing rubeosis   see   Avastin

  • surgery still needed if angle closed, but Avastin is very effective in the short term, giving vital time to protect the optic nerve from the glaucoma pressure and give time for the cyclodiode laser to be carried out and to be effective Archives

  • won't lower the pressure alone if angle is blocked with fibrotic changes (PAS)...cyclodiode is needed in addition

  • if condition is caught early, use Avastin early. If vessels are aggressive, do not wait for drops to work (drops alone are usually not effective with significant rubeosis)

  • drops...steroid and atropine

  • lowering the pressure helps reduce the rubeosis

  • in an eye that sees well consider early tube surgery...Avastin and drops whilst waiting.

  • Avastin & mitomycin trabeculectomy Spiteri Cornish 2009

 

 

rubeotic glaucoma in poorly seeing eye

(eye that sees well consider.... early tube surgery)

all eyes (if want to preserve vision) very extensive PRP when view is clear
....6000 burns over ~ sessions (laser is urgent but can nevertheless be carried out after IVA)

PAS  present in angle
yes no
if IOP high..... cyclodiode and IVA drops and IVA
cyclodiode

 


Cyclodiode settings

Cyclodiode settings for rubeotic glaucoma

  • 40 shots, 270 degrees, 1500mw   1500ms
  • spare 3 and 9 o'clock and temporal position
  • if pops, turn power lower
  • this is far more laser than needed than non-rubeotic cases
  • transilluminate ciliary body (in the dark) to find it (shine the light form the opposite side of the eye)
  • heel 1.5mm away from limbus in standard eye
  • avoid pops and carbon on the probe
  • lots of risks
  • see glaucoma for professionals

placement of cyclodiode probe

 


References 2008

Iliev ME, Domig D, Wolf-Schnurrbursch U, Wolf S, Sarra GM.
Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma.
Am J Ophthalmol. 2006 Dec;142(6):1054-6. Epub 2006 Aug 2.

Gheith ME, Siam GA, de Barros DS, Garg SJ, Moster MR.
Role of intravitreal bevacizumab in neovascular glaucoma.
J Ocul Pharmacol Ther. 2007 Oct;23(5):487-91.

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

Kahook MY, Schuman JS, Noecker RJ.
Intravitreal bevacizumab in a patient with neovascular glaucoma.
Ophthalmic Surg Lasers Imaging. 2006 Mar-Apr;37(2):144-6.

Yazdani S, Hendi K, Pakravan M.
Intravitreal bevacizumab (Avastin) injection for neovascular glaucoma.
J Glaucoma. 2007 Aug;16(5):437-9.

Grisanti S, Biester S, Peters S, Tatar O, Ziemssen F, Bartz-Schmidt KU; Tuebingen Bevacizumab Study Group.
Intracameral bevacizumab for iris rubeosis.
Am J Ophthalmol. 2006 Jul;142(1):158-60.

Chilov MN, Grigg JR, Playfair TJ.
Bevacizumab (Avastin) for the treatment of neovascular glaucoma.
Clin Experiment Ophthalmol. 2007 Jul;35(5):494-6.

 Kelkar AS, Kelkar SB, Kelkar JA, Nagpal M, Patil SP.
The use of intravitreal bevacizumab in neovascular glaucoma: a case report.
Bull Soc Belge Ophtalmol. 2007;(303):43-5.

Silva Paula J, Jorge R, Alves Costa R, Rodrigues Mde L, Scott IU.
Short-term results of intravitreal bevacizumab (Avastin) on anterior segment neovascularization in neovascular glaucoma.
Acta Ophthalmol Scand. 2006 Aug;84(4):556-7

Oshima Y, Sakaguchi H, Gomi F, Tano Y.
Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy
Am J Ophthalmol. 2006 Jul;142(1):155-8

A L Moraczewski, R K Lee, P F Palmberg, P J Rosenfeld, and W J Feuer
Outcomes of treatment of neovascular glaucoma with intravitreal bevacizumab
Br J Ophthalmol 2009;93 589-593
Hasanreisoglu M, Weinberger D, Mimouni K, Luski M, Bourla D, Kramer M, Robinson A, Axer-Siegel R.
Intravitreal bevacizumab as an adjunct treatment for neovascular glaucoma.
Eur J Ophthalmol.
2009 Jul-Aug;19(4):607-12
 

 

 

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