Abstract
Purpose: :
To examine the visual and intraocular pressure (IOP) outcomes of patients treated with intravitreal bevacizumab (Avastin) for neovascular glaucoma (NVG) secondary to diabetic retinopathy (DR) and central retinal vein occlusion (CRVO).
Methods: :
We conducted a retrospective analysis of patients receiving intravitreal injections of 1.25 mg per 0.05cc bevacizumab for NVG secondary to DR or CRVO at the Stroger Hospital of Cook County Division of Ophthalmology. All eyes displayed neovascularization of the iris (NVI) and/or neovascularization of the anterior chamber angle (NVA) at presentation. Only patients with greater than 6 months follow-up were included. All patients enrolled received informed consent including off-label usage of Avastin and complete ophthalmic examination with follow-up as medically indicated.
Results: :
A total of 14 eyes of 14 patients were included in the study. The average age was 53 years (range 35-66 years). Seven were Hispanic, 4 White, 2 African American, and 1 East Asian. The mean and median number of intravitreal injections per eye was 2 (range 1-4). Average follow-up period was 394 days (range 216-622 days). Visual acuity at last examination improved in 5 (35%), remained the same in 2 (14%), and worsened in 7 (50%). Of the 14 patients, 3 had NVG secondary to CRVO. None of those with CRVO showed improvement in visual acuity. Intraocular pressure decreased in 75%, remained constant in 17%, and increased 8%. The post-treatment decrease in IOP was statistically significant (p<0.05). All patients also had standard treatment for NVG including topical pressure lowering therapy and panretinal photocoagulation (PRP) unless vitreous hemorrhage prohibited a view. Six had cyclodiode, and 2 had cyclocryoablation. One patient received a Baerveldt glaucoma implant. No patients had adverse events due to the bevacizumab injection.
Conclusions: :
Neovascular glaucoma is a vision threatening condition that is challenging to treat. Traditional treatment regimens are often ineffective in halting or reversing the progress of this condition. In this study, adjunctive intravitreal bevacizumab was shown to decrease IOP in the majority of patients while also maintaining or improving visual acuity in half of patients. This is rare in NVG. No patients suffered adverse events from injection of intravitreal bevacizumab. Our average follow-up was greater than one year, which demonstrates long-term safety and efficacy of Avastin with relatively few injections. Further studies to examine visual acuity outcomes in patients with NVG secondary to CRVO versus DR are warranted.
Keywords: diabetic retinopathy • retinal neovascularization • clinical (human) or epidemiologic studies: outcomes/complications