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L. C. Olmos, S. Tanimoto, W. Feuer, A. L. Moraczewski, F. M. Rauscher, P. J. Rosenfeld, R. K. Lee; Bevacizumab for Treatment of Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5459.
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To compare the clinical course and visual outcomes of eyes with neovascular glaucoma (NVG) treated with and without intravitreal bevacizumab.
This is a retrospective chart review of NVG patients treated at a single institution. Patient demographic and treatment parameters (including the types and timing of any treatments such as panretinal photocoagulation, use of bevacizumab, glaucoma drainage implant surgery, and pars plana vitrectomy) were collected into a database. Clinical data recorded included visual acuities, intraocular pressures, use of glaucoma medications, and complications of treatments. Statistical analysis was performed to evaluate vision salvage, timing of glaucoma drainage implant surgery, and the effect of bevacizumab on clinical outcomes.
Bevacizumab was used in 66 NVG eyes, and the control NVG group (no bevacizumab) included 104 eyes. The main causes of NVG were similar in each group (p=0.14), with diabetes (52%, bevacizumab; 47%, control) and central retinal vein occlusion (28%, bevacizumab; 42%, control) being the most frequent causes. No statistically significant difference in either mean IOP or visual acuity at diagnosis between the group treated with bevacizumab and the control group was observed. The mean IOP at diagnosis was 40.4 mmHg in the bevacizumab group and 42.4 mmHg in the control group. The median visual acuity at diagnosis was 2/300 in the bevacizumab group and CF in the control group. Panretinal photocoagulation (PRP) was used as an initial therapy in 35% of bevacizumab eyes and 50% of control eyes. At month 3, the average number of PRP treatments was 0.68 in the bevacizumab group and 0.87 in the control group (p=0.12). At 12 month follow-up, no statistically significant difference in mean IOP (15.3 mmHg (bevacizumab) and 19.1 mmHg (control)) or median visual acuity (CF (bevacizumab) and 5/200 (control)) was observed between the two groups. When analyzed through 6 months, a borderline lower cumulative incidence of pressure lowering surgery was present in the bevacizumab group (p=0.073) but this did not persist through 12 months (p=0.14).
Bevacizumab appears to be a temporizing measure for causing rapid regression of neovascularization of the iris and angle associated with NVG. All eyes should receive panretinal photocoagulation to treat the ischemic cause of NVG. Although favorable in the short term, in this study, bevacizumab did not significantly improve vision, surgery utilization, complications, or IOP control at 6-12 months.
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