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Surgical Technique |

Neovascular Glaucoma Treatment With Extraction of Anterior Chamber Fibrovascular Tissue

Jeroni Nadal, MD, PhD1; Elisa Carreras, MD3; Bachar Kudsieh, MD3; Maribel Canut, MD2
[+] Author Affiliations
1Department of Vitreoretinal Surgery, Barraquer Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
2Department of Glaucoma, Barraquer Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
3residents at Barraquer Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
JAMA Ophthalmol. 2013;131(8):1083-1085. doi:10.1001/jamaophthalmol.2013.426.
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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 angle.

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Figure 1.
Photograph Taken From the Eye Surgery Video

Single-frame photograph taken from the eye surgery video showing unimanual fibrovascular tissue dissection with de Smet forceps on the surface of the iris.

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Figure 2.
Anterior Segment Optical Coherence Tomography

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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Neovascular Glaucoma Treatment With Extraction of Anterior Chamber Fibrovascular Tissue

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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