Efficacy and Safety of Intravitreal Bevacizumab in Eyes With Neovascular Glaucoma Undergoing Ahmed Glaucoma Valve Implantation: Long-term Follow-up

Abstract

Purpose: : To evaluate the safety and efficacy of intravitreal bevacizumab (IVB) in eyes with neovascular glaucoma (NVG) undergoing Ahmed Glaucoma Valve implantation.

Methods: : Multicenter, prospective, randomized clinical trial that enrolled 40 patients from 3 centers. All patients with uncontrolled neovascular glaucoma that had undergone panretinal photocoagulation and required glaucoma drainage device implantation were eligible. Patients were randomized to receive IVB (1.25mg) or not during Ahmed Valve implant surgery. Injections were performed intraoperatively, and 4 and 8 weeks after surgery.

Results: : After a mean follow-up of 2.25 ± 0.67 years (range 1 - 3 years), both groups showed a similar decrease in IOP. Until 12 months of follow-up, there was no statistically significant difference in IOP between groups (p=0.46). At 18 months, the IOP in bevacizumab group became statistically lower than in control group (14.57±1.72mmHg vs. 18.37±1.06mmHg - p=0.0002). There were no significant differences in mean number of medications between groups during follow-up. However, at 24 months, there was a trend to patients treated with IVB using less antiglaucoma medications than the control group (p=0.0648). At the end of follow-up, the decrease in the extension of new vessels in the angle in the IVB group was significantly greater than in the control group (p=0.0017). Although both groups showed a significant decrease in the extension of rubeosis iridis at the end of follow-up (p<0.05), complete regression of rubeosis iridis was significantly more frequent in the IVB group (80.0%) than in the control group (25%) (p=0.0015).

Conclusions: : Intravitreal Bevacizumab may lead to regression of new vessels both in the iris and the anterior chamber angle in patients with neovascular glaucoma undergoing Ahmed Glaucoma Valve implantation. Although these findings were not associated with better IOP control after a short term follow-up, at long term follow-up patients who received IVB showed lower IOPs and needed less additional medication to achieve IOP control.

Clinical Trial: : http://www.anzctr.org.au ACTRN12607000577415

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • iris • vascular endothelial growth factor