Combination intravitreal bevacizumab/panretinal photocoagulation versus panretinal photocoagulation alone in the treatment of neovascular glaucoma

Justis P Ehlers, Marc J Spirn, Andrew Lam, Arunan Sivalingam, Michael A Samuel, William Tasman
Retina 2008, 28 (5): 696-702

PURPOSE: To evaluate same-day combination intravitreal bevacizumab/panretinal photocoagulation (PRP) for the treatment of neovascular glaucoma (NVG) compared with PRP alone.

METHODS: This was an institutional review board-approved, retrospective, consecutive case-control study of patients receiving same-day combination bevacizumab/PRP or PRP alone as treatment of NVG from September 2004 through June 2007. Visual acuity, intraocular pressure (IOP), presence of anterior segment neovascularization, and required glaucoma interventional procedures were recorded.

RESULTS: A total of 23 patients were identified, 11 in the bevacizumab/PRP group and 12 in the PRP alone group. The bevacizumab/PRP group had a significant reduction in IOP compared with the PRP alone group (-11 vs. 0 mmHg, respectively; P = 0.03). There was a significantly higher frequency and rate of neovascular regression in the combination therapy group than in the PRP only group (11 vs 2 eyes [P < 0.001] and 12 vs 127 days [P < 0.0001], respectively). Average follow-up was 143 days for the bevacizumab/PRP group and 118 days for the PRP alone group.

CONCLUSIONS: Combination treatment resulted in more rapid decrease in IOP. In addition, the combination group had increased frequency and rapidity of regression of neovascularization. This study provides a foundation for further research and suggests consideration for a possible new paradigm for the treatment of NVG.

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