Abstract
Purpose::
To evaluate the efficacy of intracameral bevacizumab on neovascularization of the iris associated with proliferative retinopathies of various etiologies.
Methods::
Prior studies have determined the efficacy of intravitreal bevacizumab (Avastin) in neovascularization of iris (NVI) secondary to retinal diseases. Thirteen eyes of 13 patients with NVI secondary to proliferative diabetic retinopathy (n=8), proliferative vitreoretinopathy (n=1) and retinal vascular occlusions (n=4) received one to five serial intracameral injections of Avastin. Their mean age was 53 years (range, 32 - 85 years). The visual acuities ranged from 20/20 to "No light perception". Visual acuities, intraocular pressures (IOP) and clinical grading of rubeosis (grades 1 - 4) was recorded on each visit. Iris angiography was performed on nine patients. The patients were followed for a period of 3 - 36 weeks. Patients with neovascular glaucoma were treated medically and/or surgically to control the intraocular pressures.
Results::
Although the grade of rubeosis improved in only 3 out of 13 eyes, there was clinical regression of NVI in 11 out of 13 eyes after intracameral injection of Avastin. This included decreased caliber of vessels, less leakage from the vessels and reduced anterior chamber reaction. Majority of patients who responded, did so within a week of the first injection. Complete regression of NVI was observed in all three patients with early NVI (grades 1 and 2). Four patients required posterior segment surgery and one patient needed panretinal photocoagulation. Nine out of 13 patients had evidence of neovascular glaucoma associated with NVI. All nine patients were treated with one or more topical glaucoma medications. No adverse effects of Avastin were noted.
Conclusions::
Intracameral Avastin was efficacious in regression of NVI in patients with various retinal diseases without any major complications. It helps to reduce the acute reaction associated with NVI and NVG so that appropriate steps like posterior segment surgery, shunt surgery and laser procedures can be undertaken in a more controlled manner. This was especially helpful in patients with early NVI where complete regression was observed. Future studies will focus on determination of the dose, frequency and any toxicity with intracameral Avastin.
Keywords: neovascularization • retina • anterior chamber