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T. Larson, K. C. LaMattina, J. Chelnis, E. Wandel, C. Mata, R. M. Ahuja; Intravitreal Bevacizumab (Avastin) for Neovascular Glaucoma Secondary to Central Retinal Vein Occlusion (crvo). Invest. Ophthalmol. Vis. Sci. 2010;51(13):3579.
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To examine the visual acuity and intraocular pressure (IOP) outcomes of patients treated with intravitreal bevacizumab (Avastin) for neovascular glaucoma (NVG) secondary to central retinal vein occlusion (CRVO)
This is a retrospective, interventional case series of patients receiving intravitreal injections of 1.25 mg per 0.05cc bevacizumab for NVG secondary to CRVO at Stroger Cook County Hospital Division of Ophthalmology. All eyes displayed neovascularization of the iris (NVI) and/or neovascularization of the anterior chamber angle (NVA) at presentation, and all had IOP greater than 25 mmHg. Patients with NVG secondary to other causes were excluded. All patients received a complete ophthalmic examination on initial presentation, and all gave informed consent including off-label use of Avastin.
A total of 8 eyes of 8 patients were included in the study. 5 patients were male; 3 were female. The average age was 58.5 years (range 47 to 68). Three patients were African American, 2 white, 1 Hispanic, 1 Filipino and 1 East Indian. The mean number of intravitreal injections per eye was 1.75 (range 1 to 2). Average follow-up time was 304 days (range 116 to 832). Mean time for complete NVI regression was 106 days; the shortest time was 7 days. Visual acuity at last examination improved in 1 eye, remained the same in 4, and worsened in 3. Final visual acuity ranged from 20/50 to NLP. Mean initial IOP was 34.5 mmHg, and mean final IOP was 27.8 mmHg. Compared with IOP at presentation, IOP at last follow-up decreased in 5 eyes and increased in 3. All patients also had standard treatment for NVG. Six patients had cyclodestructive procedures, 5 within 2 to 8 days of initial presentation and 1 at 106 days. No patients had adverse events secondary to the intravitreal Avastin.
The significant ocular ischemia found in patients with CRVO further complicates the many treatment challenges in NVG. While intravitreal bevacizumab did aid in more rapid regression of NVI, a majority of patients required adjunctive cyclodestructive procedures to manage IOP. Although visual acuity was maintained or improved in 5 patients, there was still significant visual morbidity. Our average follow-up time of close to one year demonstrates long-term safety of intravitreal bevacizumab. Larger controlled studies are warranted to determine appropriate clinical management of NVG secondary to CRVO.
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