Intravitreal bevacizumab and aqueous shunting surgery for neovascular glaucoma: safety and efficacy

Tarek M Eid, Ashraf Radwan, Wael el-Manawy, Ihab el-Hawary
Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie 2009, 44 (4): 451-6

OBJECTIVE: To study the safety and efficacy of intravitreal injection of bevacizumab followed by aqueous shunting tube surgery for the management of neovascular glaucoma (NVG).

STUDY DESIGN: A prospective, non-randomized study with a historical control group.

PARTICIPANTS: Twenty eyes of 20 patients with intractable NVG were treated with intravitreal injection of bevacizumab followed by aqueous shunting surgery (IVB group). A historical group of 10 NVG eyes treated with panretinal photocoagulation followed by aqueous shunting surgery without bevacizumab injection was used for comparison (PRP group).

METHODS: Injection of bevacizumab (1.25 mg/0.05 mL) was performed under topical anesthesia. An Ahmed valve was implanted in all cases after 1-2 weeks. In the IVB group, 10 eyes received postoperative panretinal photocoagulation (subgroup 1A), and 10 eyes were followed without further photocoagulation (subgroup 1B). Minimum follow-up was 1 year or when failure was diagnosed.

RESULTS: Mean preoperative intraocular pressure (IOP) was 46.5 mm Hg in the IVB group and 49.2 mm Hg in the PRP group (p = 0.5). After bevacizumab injection, iris neovessels regressed markedly. The final IOP after aqueous shunting tube surgery was 18.8 mm Hg in the IVB group and 15.9 mm Hg in the PRP group (p = 0.2). Postsurgical complications were comparable between the groups. The success rate was 85% and 70% in the 2 groups, respectively. Two eyes were considered failures, and 3 required repeated bevacizumab injections in subgroup 1B as compared with 1 in subgroup 1A.

CONCLUSION: Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in NVG. Panretinal photocoagulation after bevacizumab injection promotes the success rate of aqueous shunt surgery by permanent ablation of the ischemic retina.

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