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C. N. Romeiro, B. R. A. Nassaralla, J. J. Nassaralla, Jr.; Intraocular Bevacizumab (Avastin) for Rubeosis Iridis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4572.
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Bevacizumab (Avastin®, Roche, Rio de Janeiro, Brazil) is an anti-VEGF recombinant humanized monoclonal IgG1 antibody used to treat colorectal cancers. Bevacizumab may have a role in treating ocular disorders involving fibrovascular proliferation. To determine whether intraocular bevacizumab decreases rubeosis iridis in patients with neovascular glaucoma.
The study included 25 eyes of 22 patients with secondary neovascular glaucoma due to proliferative diabetic retinopathy (n=19) or ischemic vessel occlusion (n=6). All patients received an intraocular injection of 1.25 mg of bevacizumab. Intraocular injection was performed in topical anaesthesia either in the anterior chamber (n=22) or via pars plana intravitreally (n=1). Rubeosis iridis was investigated prospectively by iris biomicroscopy. An expanded informed consent with an off-label use waiver and explanation letter was reviewed with all patients. The intraocular injection was performed under sterile conditions in an operating theatre and was performed with proximetacaine (Anestalcon® - Alcon - Brazil) topical anesthesia and the injection did via pars plana.
Degree of rubeosis iridis decreased significantly (p<0.01) within 1 week after application. The improvement was maintained for at least 4 weeks. An inflammatory response with fibrinous reaction and pseudohypopyon was observed in one case one day after surgery. The reaction persisted only 1 day.
Intraocular injection of bevacizumab may provide an additional strategy to the treatment of rubeosis iridis. Its long term effect and impact on neovascular glaucoma has to be determined. The number of patients in this pilot study was limited and the follow-up is too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed. More studies are needed to evaluate the effect of this medication prior to clinical use.
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