Good Hope, Heartlands, and Solihull Eye Clinics

Rubeotic glaucoma for professionals, some notes

David Kinshuck

Treatment plan

IVA (Avastin...Bevacizumab)

  • is very effective in reducing rubeosis   see   Avastin
  • surgery still needed if angle closed, but Avastin is very effective in the short term, giving vital time to protect the optic nerve from the glaucoma pressure and give time for the cyclodiode laser to be carried out and to be effective Archives
  • won't lower the pressure alone if angle is blocked with fibrotic changes (PAS)...cyclodiode is needed in addition
  • if condition is caught early, use Avastin early. If vessels are aggressive, do not wait for drops to work (drops alone are usually not effective with significant rubeosis)
  • drops...steroid and atropine
  • lowering the pressure helps reduce the rubeosis
  • in an eye that sees well consider early tube surgery...Avastin and drops whilst waiting.
  • Avastin & mitomycin trabeculectomy Spiteri Cornish 2009
  • PRP laser most important, avastin temporary  Eye 16

  • rubeotic glaucoma in poorly seeing eye
  • (eye that sees well consider.... early tube surgery)
  • all eyes (if want to preserve vision) very extensive PRP when view is clear
    ....6000 burns over ~ sessions (laser is urgent but can nevertheless be carried out after IVA)
PAS  present in angle
yes no
if IOP high..... cyclodiode and IVA drops and IVA
cyclodiode

 

Cyclodiode settings

placement of cyclodiode probe

Cyclodiode settings for rubeotic glaucoma

  • 40 shots, 270 degrees, 1500mw   1500ms
  • spare 3 and 9 o'clock and temporal position
  • if pops, turn power lower
  • this is far more laser than needed than non-rubeotic cases
  • transilluminate ciliary body (in the dark) to find it (shine the light form the opposite side of the eye)
  • heel 1.5mm away from limbus in standard eye
  • avoid pops and carbon on the probe
  • lots of risks
  • see glaucoma for professionals