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Ekaterina A Semenova, Sonali Nagendran, Paul T Finger; Intravitreal bevicizumab anti-vascular endothelial growth factor therapy for radiation associated neovascular glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5094.
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To describe the effects of intravitreal bevicizumab anti-vascular endothelial growth factor therapy on radiation associated neovascular glaucoma.
This is a retrospective single centre interventional case series examining 12 eyes of 12 patients with ocular malignancies (10 uveal melanoma, 1 conjunctival melanoma, 1 ciliary body adenocarcinoma) who developed neovascular glaucoma after radiation therapy (11 plaque brachytherapy and 1 external beam teletherapy). All patients were treated with periodic 1.25 mg intravitreal bevicizumab injections. Outcome measures assessed included regression of iris neovascularization, change in intraocular pressure (IOP), visual acuity, pain control and enucleation.
Regression of iris neovascularization occurred in 9/12 patients after the first injection. The intraocular pressure (IOP) decreased in 8/12 patients (67%) with a mean reduction of 9.25 mmHg across the study group. Visual acuity improved in 1/12 (8%), remained stable in 5/12 (42%) and deteriorated in 6/12 (50%). Patients were monitored for 24 months on average after the first injection. Six eyes subsequently underwent enucleation for pain control (4 patients, 66%), chronic uveitis (1 patient, 17%) and tumor recurrence (1 patient, 17%). The 6 patients that retained their eyes reported good pain control. Visual acuity ranged from 20/160 to no light perception. Intraocular pressures remained within the normal range in 4 patients, 3 of whom required continued periodic bevicizumab injections. Two patients had significantly raised but stable IOP and opted to stop treatment.
Intravitreal bevicizumab is a promising treatment for patients with radiation associated neovascular glaucoma who wish to avoid enucleation. Although visual acuities did not improve, there was clinical evidence of regression of iris neovascularization and treatment achieved pain control and acceptable IOP control in the majority of patients.
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