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M. K. Eide, P. L. Tsai, N. J. Pathak, K. K. Kamat, K. M. Riaz, R. M. Ahuja; Intravitreal Bevacizumab (Avastin) in Patients With Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5590.
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To examine the effect of intravitreal bevacizumab in neovascular glaucoma (NVG) secondary to diabetic retinopathy (DR) and central retinal vein occlusion (CRVO).
A retrospective analysis of patients given intravitreal injections of 1.25 mg (0.05cc) bevacizumab for neovascular glaucoma secondary to DR or CRVO was performed 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) with an elevated intraocular pressure (IOP) prior to injection. All patients enrolled received informed consent and a complete ophthalmic examination.
Of the 11 patients included in the study, nine were male. The average age was 53 years (35 to 66 years). The mean follow-up period was 6 months (range 2 weeks to 9 months). Three patients had NVG secondary to a CRVO. Eight patients also received panretinal photocoagulation (PRP) within 3 days of the injection. Three did not receive PRP in the peri-injection period due to dense vitreous hemorrhage. Near complete regression of NVI occurred in all 11 patients presenting with this finding, the earliest in 2 days (mean 47 days). Complete regression occurred in 6 of 9 patients with NVA, the earliest in 7 days (mean 83 days). Eight patients (73%) maintained or improved visual acuity during follow-up. Five patients required a repeat injection due to either failure of complete resolution or recurrence of neovascularization. Topical eye drops alone controlled IOP in 6 patients. One patient underwent alloplastic tube shunt placement 12 days after injection. Four patients underwent cyclodiode laser ablation. No adverse events were seen as a result of bevacizumab injection.
Neovascular glaucoma is a visually devastating condition that presents a very difficult management challenge. Conventional management is often insufficient. Vascular endothelial growth factor plays an important role in the pathophysiology of NVG. In our study, intravitreal bevacizumab injection as adjunctive therapy for NVG was effective in aiding short-term rapid regression of both NVI and NVA, and also appeared to be safe and well tolerated. In the majority of patients, visual acuity was either maintained or improved which is traditionally rare in NVG. Additional study is necessary to determine the long-term safety and efficacy of intravitreal bevacizumab in patients with NVG.
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