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T. Filippopoulos, S. K. Rao, N. P. Katsoulakis, J. F. Ducharme, M. G. Krzystolik; Long Term Follow-Up of Antiangiogenic Agents as Adjunctive Treatment in Patients With Complicated Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1203.
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Antiangiogenic agents, like pegaptanib and ranibizumab have been shown to be safe for intravitreal injections in age-related macular degeneration and have been used off label as adjuncts in the treatment of neovascular glaucoma. We present our experience with the off-label use of antiangiogenic agents like pegaptanib (Macugen®), ranibizumab (Lucentis®) and bevacizumab (Avastin®) as adjuncts in the treatment of neovascular glaucoma in patients with extended follow-up.
Retrospective, uncontrolled, interventional, non-comparative case series of seven patients (n=7 eyes) with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal artery occlusion. One patient was injected with 0.3mg of pegaptanib and five patients with 1.25 mg of bevacizumab. One patient was injected pegaptanib and subsequently switched to 0.5mg of ranibizumab. Primary outcome measures were regression of rubeosis, intraocular pressure (IOP) control after glaucoma filtration surgery and medical therapy as necessary, rate of phthisis, hypotony and/or enucleation. Secondary outcomes included safety data, visual acuity at the last follow-up, requirement for glaucoma filtration surgery, PRP or vitrectomy, need for subsequent re-injections.
Average age was 63.4 ± 12.9 years. Average length of follow-up was 37.6 ± 36.3 weeks. Four out of seven patients had received full panretinal photocoagulation (>2000 spots) prior to the injections. Pegaptanib and bevacizumab caused complete regression of iris neovascularization within 7-9 days. The IOP at presentation and at the last follow-up visit was 34.3 ± 10.5 and 15.1 ± 3.2 mmHg respectively (p=0.0006, t-test). Five patients required glaucoma filtration surgery (Baerveldt Glaucoma Implants in all cases) but none a cyclodestructive procedure. Two eyes were re-injected due to reappearance of rubeosis. No eye developed phthisis, hypotony or was enucleated. All patients tolerated the intravitreal injections well without systemic complications; however, one patient developed a sterile hypopyon that was temporally not associated with the injection. Vision improved in 4 eyes, remained stable in one and deteriorated in 2 eyes.
Antiangiogenic agents may be helpful adjuncts in managing patients with neovascular glaucoma. Randomized controlled clinical trials are warranted to investigate their specific indications.
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