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The use of antibody to vascular endothelial growth factor to treat neovascular glaucoma yields
good anatomic results in most cases. However, this type of glaucoma can cause angle closure with
decompensation of intraocular pressure secondary to fibrovascular tissue contraction in the anterior
chamber. Our surgical technique treats the cause by removing the anterior chamber fibrous complex
after administration of antibody to vascular endothelial growth factor, thus restoring the chamber
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Single-frame photograph taken from the eye surgery video showing unimanual fibrovascular tissue dissection with de Smet forceps on the surface
of the iris.
Optical coherence tomography of the anterior segment showing an open angle after anterior chamber
fibrovascular tissue dissection and injection of antibody to vascular endothelial growth factor.
Good intraocular pressure control was achieved in this patient.
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The first step is to inject bevacizumab into the anterior chamber 48 to 72 hours before repair
surgery. Corneal paracentesis is performed, immediately followed by anterior chamber washout. Then,
trypan blue is injected into the anterior chamber under air to stain the fibrovascular tissue. This
is followed by viscosurgery to mechanically separate the fibrotic tissue from the iris stroma. With
alternating unimanual and bimanual techniques, de Smet forceps and scissors are used to extract
fibrovascular tissue from the surface of the iris, the angle, and the pupil area. Finally, the
viscoelastic is removed from the anterior chamber and 0.05 mL of bevacizumab is again injected.
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Neovascular Glaucoma Treatment With Extraction of Anterior Chamber Fibrovascular Tissue
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