Intravitreal injection of bevacizumab to treat neovascular glaucoma

Abstract

tendon, and it covered the tissue plane of the levator aponeurosis and the levator palpebrae superioris muscle.An excisional biopsy of the mass was performed to confi rm the diagnosis. During the surgery, a mass was found just beneath the orbital septum with an anterior intraorbital extension, and a biopsy specimen was removed. Histopathological comparison of the specimen was then made with the previous esophageal biopsy specimen from this patient. The eyelid biopsy revealed a moderately differentiated metastatic squamous cell carcinoma (Fig. 2).After the diagnosis, the patient underwent palliative chemotherapy, but unfortunately the mass recurred 2 months after the surgery. Subsequent systemic work-up revealed lung and brain metastases. CommentsThe most common features associated with orbital masses are acquired strabismus, blepharoptosis, proptosis, periorbital swelling, pain, reduced vision, 2,3 and headaches. 4 In our case, the apparent signs were blepharoptosis and acquired strabismus. As far as we know, metastasis of an esophageal squamous cell carcinoma to the anterior orbit involving the orbital septum is rare. In 1990, Goldberg et al. 1 reported that in a large series of orbital metastases there were ten cases of gastrointestinal tract tumors that metastasized to the orbit. The most common sites of these were the stomach, ileum, and colon.Esophageal cancer is a treatable disease, but it is rarely curable. The risk factors for squamous cell carcinoma of the esophagus have been identifi ed as smoking, alcohol consumption, and diet. 5 The 5-year overall survival rate in patients amenable to defi nitive treatment ranges from 5% to 30%. The fi ndings in our case highlight the need for increased awareness of the potential for orbital metastasis, especially of an esophageal primary neoplasm. It also reinforces the need for imagery-based investigations to detect the early stage of metastasis and blepharoptosis in patients with esophageal squamous cell carcinoma.

Angiographic Changes in Iris and Iridocorneal Angle Neovascularization After Intravitreal Bevacizumab Injection

“…5 Recent studies have reported that the off-label use of intravitreal (IV) injection of bevacizumab is an effective and safe treatment for NVG. [6][7][8][9][10][11][12][13][14][15] Intravitreal injection of bevacizumab leads to a dramatic regression of the new iris and angle vessels and a decrease in IOP, although these effects may be transient owing to the drug's short half-life. 16 The effects of bevacizumab on the vasculature of the anterior ocular segment, however, are unknown.…”

“…24 In the present study, the IOP showed a decrease in 3 of 4 eyes after IV bevacizumab injection. Previous studies 13 reported that IV bevacizumab injection leads to a reduction of the IOP in eyes with earlystage NVG. Three of 4 eyes in the present series exhibited IOPs within the reference range after IV bevacizumab injection, when dye leakage was minimal with FA.…”

Sterile Endophthalmitis After Intravitreal Injection of Bevacizumab Obtained From a Single Batch

“…After the efficacy of intravenous bevacizumab on age-related macular degeneration was shown, it was administered intravitreally, 3,4 and the injection of intravitreous bevacizumab (IVB) began to be used widely for treatment of various ocular diseases, including branch retinal vein occlusion, 5,6 polypoidal choroidal vasculopathy, 7,8 retinal angiomatous proliferation, 9,10 myopic choroidal neovascularization (CNV), 11,12 CNV secondary to angioid streaks, 13,14 proliferative diabetic retinopathy, 15,16 and neovascular glaucoma. 17,18 Intravitreous bevacizumab can cause complications, including traumatic cataract, retinal detachment, and endophthalmitis, with the reported incidence of endophthalmitis ranging from 0.014% to 0.082%. 19 -24 Although several cases of sterile endophthalmitis have been reported, most of these cases have been sporadic, and in most instances, the inflammation subsided with no treatment or with topical treatment.…”

Risk factors for requirement of filtration surgery after vitrectomy in patients with proliferative diabetic retinopathy

“…Previous studies have identified several risk factors for NVG after vitrectomy, including obvious preoperative neovascularization of the iris/angle, male sex, and postoperative retinal detachment. 3 , 6 , 7 The reported treatments for NVG include intravitreal injection of an anti-vascular endothelial growth factor (anti-VEGF) agent, 8 – 10 additional retinal photocoagulation, and trabeculectomy or tube shunt surgery for closed-angle NVG or other conditions unresponsive to intraocular pressure (IOP) reduction therapy. 11 , 12 …”