Glaucoma Could Make or Break Visual Acuity Improvement in ASNV Patients


A comparison of patients with either anterior segment neovascularization without glaucoma or neovascular glaucoma found the benefits of anti-VEGF and PRP are heavily influenced by the presence of glaucoma.

One of the first studies to assess the post-treatment visual outcome of patients with anterior segment neovascularization without glaucoma (ASNV) found that it is a potentially more manageable condition than neovascular glaucoma (NVG).

The study, presented at the American Society of Retina Specialists (ASRS) Annual Meeting in Vancouver, BC, directly assessed the influence of glaucoma at disease presentation, and whether it influences patient visual outcomes.

Led by Hossein Ameri, MD, PhD, assistant professor of clinical ophthalmology at the Keck School of Medicine of USC, researchers assessed 378 relevant patients’ eyes observed between 2005-2015 at the Los Angeles County and University of Southern California Medical Center. According to the study, 294 (77.8%) eyes had NVG and 84 (22.2%) had ASNV at presentation.

ASNV was defined as neovascularization of the iris or an angle with intraocular pressure of 21 mmHg or less. Researchers excluded eyes subjected to prior intraocular surgery, prior use of IOP-lowering eyedrop therapy, other concurrent forms of glaucoma, or other forms of visually significant pathology.

Researchers compared average best corrected visual acuity (BCVA) between the 2 groups using a two-sample t-test to assume unequal variance. Mean patient follow-up period was 1.5 years. Patients in both groups were treated with either pan retinal photocoagulation (PRP), anti-vascular endothelial growth factor (VEGF) intravitreal bevacizumab, or both.

At presentation, eyes with ASNV presented significantly better BCVA (20/200) than eyes with NVG (20/2000; P <0.0000003). While 71 (24.1%) of eyes with NVG had VA of light perception (LP) or worse, none were reported in the eyes with ASNV.

Final BCVA was again significantly better in eyes with ASNV (20/100) compared to NVG (20/1800; P <0.0006). The rate of NVG eyes with VA rates of LP or worse had increased to 103 (35.0%), while no eyes with ASNV develop LP or worse.

Within 6 months of the study, 9 (10.7%) of the eyes with ASNV developed NVG despite treatment, required glaucoma tube shunt. The final BCVA of these eyes were significantly worse in comparison to those which did not develop NVG (6ft/200 versus 20/125; P = 0.03).

Ameri told MD Magazine® the study results reinforce what was previously understood by researchers: that patients with NVG need consistent, aggressive treatment—as do patients with ASNV.

“Even those who did not develop glaucoma, we have to be aggressive in treating them, and perhaps treating them with both the anti-VEGF and with PRP, and doing that right at day 1 rather than delaying the treatment,” Ameri said.

Further analysis should consider following such patients beyond 1 or 2 years of care, Ameri said, as additional treatment is often needed for patients with ASNV in the months following initial diagnosis.

The study, "Comparison of Visual Outcome in Neovascular Glaucoma to Anterior Segment Neovascularization Without Glaucoma," was presented at ASRS 2018 on Monday.

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