Aims To compare the outcomes of neovascular glaucoma (NVG) treated with and without intravitreal bevacizumab in a large case comparison study. Methods The study is a retrospective, comparative, case series of 163 eyes of 151 patients with NVG, including 99 treated without and 64 treated with intravitreal bevacizumab. Medical and surgical treatments for NVG were assessed. The main outcome measures were visual acuity (VA) and intraocular pressure (IOP).Results At the time of NVG diagnosis, the median VA was count fingers (CF) in the non-bevacizumab group and 2/300 in the bevacizumab group. IOP (mean ± SD) was 43.1 ± 13.0 mm Hg in the non-bevacizumab group and 40.8 ± 11.5 mm Hg in the bevacizumab group. IOP (mean ± SD) decreased to 18.3 ± 13.8 mm Hg in the nonbevacizumab group and 15.3 ± 8.0 mm Hg in the bevacizumab group, and the median VA was CF in both treatment groups at a mean follow-up of 12 months. Panretinal photocoagulation (PRP) substantially reduced the need for glaucoma surgery (Po0.001) in bevacizumab treated NVG eyes. Conclusions Although bevacizumab delayed the need for glaucoma surgery, PRP was the most important factor that reduced the need for surgery. Vision and IOP in eyes with NVG treated with bevacizumab showed no long-term differences when compared with eyes that were not treated with bevacizumab. Thus, intravitreal bevacizumab serves as an effective temporizing treatment, but is not a replacement for close monitoring and definitive treatment of NVG. PRP remains the treatment modality that affects the course of NVG in terms of decreasing the need for surgery to control IOP.

Penetrating keratoplasty (PKP) is associated with an increased risk of secondary glaucoma. The development of glaucoma after PKP is an important risk factor for decreased corneal graft survival. The incidence of glaucoma after corneal transplant as well as the mechanism of developing increased intraocular pressure is reviewed in this paper. Treatments for post-PKP glaucoma include medications, laser, and surgery. The most frequent surgical glaucoma intervention is implantation of a glaucomadrainage device. Recent advances in corneal transplantation surgery may help to decrease corneal failure and the risk of developing post-keratoplasty glaucoma.

Another aspect of NVG prevention is represented by treating the patients with central/hemi-CRVOs in whom ocular neovascularization already has appeared but IOP still remains within normal limits (eg, the preglaucomatous stage of NVG 2 ). In such cases we administer IVB injections, topical steroids, and cycloplegics; unless the neovascularization subsides with these treatments, we promptly apply panretinal photocoagulation that may prevent or delay any developing of the intractable sightthreatening NVG.In conclusion, we believe that at a dose of 2.5 mg injected promptly before occurrence of neovascularization and IOP elevation, IVB offers a real benefit and promise for the prevention of NVG in patients with acute central/hemi-CRVOs. Early diagnosis and treatment with bevacizumab are required in order to maintain a good visual status and a satisfactory IOP control. Conflict of interestThe authors declare no conflict of interest. Author contributionsBoth authors (DC and MC) were involved in design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.