Intravitreal bevacizumab as an adjunct treatment for neovascular glaucoma

Murat Hasanreisoglu, Dov Weinberger, Karin Mimouni, Moshe Luski, Dan Bourla, Michal Kramer, Anat Robinson, Ruth Axer-Siegel
European Journal of Ophthalmology 2009, 19 (4): 607-12

PURPOSE: To assess the effect of adjunctive intravitreal bevacizumab treatment on neovascular glaucoma (NVG).

METHODS: The medical records of all consecutive patients with NVG treated with intravitreal bevacizumab at our center from May 2006 to February 2008 were reviewed. The data collected included background features, findings on full ophthalmologic examination (including visual acuity, gonioscopy, and intraocular pressure), glaucoma medications prescribed, and additional procedures for glaucoma performed before and after bevacizumab injection.The interval between the diagnosis of NVG and intravitreal bevacizumab treatment was calculated.

RESULTS: Eighteen patients (6 male, 12 female; mean age 63-/+13.2 years) met the study criteria. Causes of NVG were proliferative diabetic retinopathy (n=14), central retinal vein occlusion (n=2), occlusive vasculitis (n=1), and panuveitis (n=1). The mean duration of followup was 52 (-/+12) weeks. Mean intraocular pressure decreased from 32.3 (-/+4.99) to 18 (-/+6.1) mmHg (p<0.0001) and mean number of glaucoma medications decreased from 3.16 (-/+1.2) to 2.55 (-/+1.46) (p=0.1938). An interval of less than 6 months between the start of bevacizumab treatment and diagnosis was associated with better final visual acuity than delayed treatment (0.82-/+0.4 logMAR vs 1.88-/+1.1 logMAR, p=0.002) and a better regression of iris neovascularization (22% vs 89%; p=0.015).

CONCLUSIONS: Intravitreal bevacizumab is beneficial for the treatment of anterior segment neovascularization and NVG when used as an adjunct, making the administration of additional treatment for the underlying cause possible. Bevacizumab should be instituted promptly after diagnosis, before irreversible anatomic and functional damage occurs.

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