Evaluation and Current Treatment Modalities of Neovascular Glaucoma

Abstract

Purpose: : To study the efficacy of bevacizumab in the management of neovascular glaucoma (NVG).

Methods: : This is a retrospective chart review evaluating patients who underwent treatment for NVG at Kresge Eye Institute from 2001-2010. NVG patients who were treated with a combination of bevacizumab/PRP, bevacizumab/PRP/Valve, or bevacizumab alone were compared to patients treated for NVG without the use of bevacizumab. Patients were followed for 12 months after their therapeutic intervention and evaluated for intraocular pressure (IOP) control. Failure was defined as IOP > 21 on two consecutive visits or need for additional therapy (medical or surgical) to control IOP. In addition subgroup analysis was done on each treatment modality to see if one yielded a better survival rate.

Results: : 42 patients met inclusion criterion. 24 patients had received bevacizumab (4 bevacizumab only, 10 PRP/bevacizumab, 10 with PRP/bevacizumab/valve). 18 patients had PRP and valve surgery (control). Mean age was 59.5 yrs +/- 15.52 in the bevacizumab group and 57.5 yrs +/- 13.29 (p=0.66) in the control group. The average pre-operative IOP was 44.04+/- 3.34 for bevacizumab group and 50.22+/- 3.35 (p=0.21) for control group. The average post operative IOP at one year was 17.95+/- 3.30 for the bevacizumab group and 15.33 +/- 1.54 for the control group. The average reduction in IOP at one year in the bevacizumab group was 25.48 +/- 4.76 (p = <0.0001) and 34.89 +/- 3.16 (p = <0.0001) in the control group. Survival analysis was performed with Kaplan-Meier estimator. The 1 yr survival rate of the bevacizumab group was 0.30 +/- 0.09 and the control group was 0.45 +/- 0.12 (p = 0.40). Subgroup analysis showed the survival rates at 1 year of 0.00, 0.25, 0.45, and 0.60 (p=0.049) for panretinal photocoagulation (PRP) with bevacizumab, bevacizumab alone, PRP with valve surgery or PRP with bevacizumab and valve surgery respectively.

Conclusions: : Patients that received bevacizumab along with other treatment modalities for NVG had an equivocal survival rate at 1 year when compared to patients who didn’t receive bevacizumab. On subgroup analysis patients who were treated with PRP with bevacizumab and valve surgery showed a trend towards a better survival rate compared to all other treatment modalities.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • intraocular pressure • neovascularization