Wound dehiscence and device migration after subconjuntival bevacizumab injection with ahmed glaucoma valve implantation

Abstract

Purpose:To report a complication pertaining to subconjunctival bevacizumab injection as an adjunct to Ahmed Glaucoma Valve (AGV) implantation.Case Report:A 54-year-old woman with history of complicated cataract surgery was referred for advanced intractable glaucoma. AGV implantation with adjunctive subconjunctival bevacizumab (1.25 mg) was performed with satisfactory results during the first postoperative week. However, 10 days after surgery, she developed wound dehiscence and tube exposure. The second case was a 33-year-old man with history of congenital glaucoma and uncontrolled IOP who developed AGV exposure and wound dehiscence after surgery. In both cases, for prevention of endophthalmitis and corneal damage by the unstable tube, the shunt was removed and the conjunctiva was re-sutured.Conclusion:The potential adverse effect of subconjunctival bevacizumab injection on wound healing should be considered in AGV surgery.

Use of Anti-VEGF Agents in Glaucoma Surgery

“…A prospective trial by Sengupta et al comparing bevacizumab with either sponges or injection to MMC sponges used at the time of filtering surgery documented a case of conjunctival necrosis in the bevacizumab injection group [ 41 ]. Finally, Miraftabi and Nilforushan reported two cases of severe conjunctival dehiscence following placement of a glaucoma drainage implant with intraoperative subconjunctival injection of bevacizumab [ 42 ]. While most studies document a lesser effect of the anti-VEGF agents compared to MMC or 5-FU, these agents are not without risk and complications may still occur in a subset of patients.…”

Glaucoma Drainage Device Erosions in Patients Receiving Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy

“…However, further studies in this field are necessary to elucidate the precise mechanism in which anti-VEGF intravitreal injections may increase the rate of GDD erosion. 9,10 The present study compares the rates of GDD erosion between patients receiving intravitreal anti-VEGF and those not receiving anti-VEGF for the treatment of diabetic retinopathy. A subgroup analysis was performed for patients also receiving intravitreal steroids for the treatment of diabetic retinopathy.…”

“…Similarly, since topical steroids have been associated with an increased rate of GDD erosions in prior studies, we hypothesize that intravitreal steroids will also increase this risk. [3][4][5][6]9,10…”

“… 9 Miraftabi et al also described two cases of combined subconjunctival anti-VEGF with GDD implantation that resulted in GDD exposure. 10 The mechanism of GDD exposure after anti-VEGF is unclear but could be multifactorial. First, manipulation and trauma to the conjunctiva can result in conjunctival erosion and subsequent GDD exposure.…”

“…However, further studies in this field are necessary to elucidate the precise mechanism in which anti-VEGF intravitreal injections may increase the rate of GDD erosion. 9 , 10 …”