Purchase this article with an account.
T. Filippopoulos, J.F. Ducharme, J.I. Loewenstein, M.G. Krzystolik; Antiangiogenic Agents as an Adjunctive Treatment for Complicated Neovascular Glaucoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4476.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Neovascular glaucoma, in association with vitreous hemorrhage and/or cataracts, represents a challenge and is associated with poor visual outcomes. Often, preoperative treatment with laser photocoagulation is not possible because of unclear media. Intravitreal injection of triamcinolone reduces postoperative progression of iris neovascularization presumably due to its anti–proliferative and anti–inflammatory properties. Selective antiangiogenic agents, like pegaptanib, have been shown to be safe in treating exudative age–related macular degeneration and may expand our armamentarium in the treatment of neovascular glaucoma.
To evaluate the off–label use of pegaptanib and bevacizumab as adjuncts in the treatment of neovascular glaucoma.
Retrospective review of four patients (n=4 eyes) with type II diabetes mellitus, rubeosis iridis and cataract and/or vitreous hemorrhage precluding preoperative panretinal photocoagulation. Two patients were injected with 0.3 mg of pegaptanib into the vitreous and two patients with 1.25 mg of bevacizumab. Discussion with the patients about the lack of clinical trials and informed consent preceded the injections. The injections were performed on an individualized basis. Primary outcome was regression of rubeosis. Secondary outcomes were safety data, visual acuity after cataract extraction and/or pars plana vitrectomy, requirement of glaucoma filtration surgery and IOP on maximal medical therapy. Iris neovascularization was documented with photography before and after the intravitreal injections. Average length of follow–up was 8 ± 8.7 weeks.
Average age at presentation was 59.5 ± 13 years, average duration of diabetes was 14 ± 3.8 years, and all patients but one had received full panretinal photocoagulation (>2000 spots) prior to the intravitreal injections. Their median visual acuity at presentation was HM to CF. Both agents caused complete regression of iris neovascularization within 7–9 days. The pre– and post–operative intraocular pressures were 32.3 ± 11.5 and 25.0 ± 16.5 mmHg respectively, with two patients requiring Baerveldt tube placement. The median visual acuity improved to 20/200 on last follow–up. All patients tolerated the intravitreal injections without short term complications.
Antiangiogenic agents may be helpful adjuncts for patients with neovascular glaucoma. Randomized controlled clinical trials are warranted.
This PDF is available to Subscribers Only