Efficacy and Safety of Intracameral Bevacizumab for Treatment of Neovascular Glaucoma

Abstract

PurposeTo evaluate the long-term efficacy and safety of intracameral bevacizumab in patients with neovascular glaucoma.MethodsThis retrospective study included 26 eyes of 26 neovascular glaucoma patients who received intracameral bevacizumab injection between January 2013 and May 2015, and were followed-up for at least 1 year. All patients were treated with topical and/or systemic intraocular pressure (IOP)-lowering medications, intracameral bevacizumab, and panretinal photocoagulation (PRP). The main outcome measures were changes in visual acuity, IOP, and neovascularization of the iris (NVI) and the anterior chamber angle (NVA). To assess the safety of intracameral bevacizumab, corneal endothelial changes were also determined using specular microscopy. Patients whose IOP was uncontrolled received IOP-lowering surgery. Clinical factors associated with IOP-lowering surgery were also investigated.ResultsIn all patients, intracameral bevacizumab resulted in a rapid and marked reduction of IOP, NVI, and NVA within 1 week. At 12 months after initial injection, 19 of 26 eyes (73%) underwent IOP-lowering surgery. The average interval between initial injection and surgical treatment was 33.6 ± 26.9 days. Baseline IOP (p = 0.018), NVA grade (p = 0.029), and incomplete PRP (p = 0.005) were identified as predictive factors for IOP-lowering surgery. During the follow-up period, there were no statistically significant corneal endothelial changes after intracameral bevacizumab injection.ConclusionsDuring 1 year of follow-up after intracameral bevacizumab, the procedure was found to be safe for the corneal endothelium. However, the IOP-lowering effect was transient, and 73% of patients eventually required IOP-lowering surgery. Predictive factors for IOP-lowering surgery were high baseline IOP and NVA grade, and incomplete PRP.

Intracameral Bevacizumab versus Subconjunctival Bevacizumab in the Treatment of Neovascular Glaucoma

“…Intracameral Bevacizumab was followed-up for eight months in our study and it was considered a safe procedure for corneal endothelium. Other studies evaluated the safety of intracameral Becacizumab for NVG and found no side effects on corneal endothelim 19,20 .…”

“…Other studies showed that IOP and NVI rapidly decreased after intracameral Bevacizumab but to control new vessels a single intracameral injection was not enough 2,17 . In our study, the patients received 3.45 ± 1.73 (group A) and 3.12 ± 2.10 (group B) injections, and 9 (32.1%) and 4 (40.0%) eyes received more than two injections in group A and B, respectively, similar to Ha JY et al study 2 .…”

“…Neovascular glaucoma (NVG) most commonly results from conditions, which lead to retinal ischemia 1 . Various diseases are involved in its occurrence including proliferative diabetic retinopathy (PDR), retinal vein occlusion, ocular ischemic syndrome, and chronic uveitis resulting in elevated intraocular pressure (IOP) and severe vision loss 2 . Retinal ischemia is a common factor in most of these diseases; only 3% of NVG cases are not associated with retinal ischemia 3 .…”

“…In many studies, rapid and obvious therapeutic effects of intravitreal Bevacizumab have been reported, but little is known about the long-term efficacy of intracameral injection 11 . Most patients eventually required laser or surgical procedures for IOP control, but few studies on the predictive factors have been reported for surgical treatment in spite of intraocular injection, especially intracameral injection 2,7 .…”

What is the impact of intravitreal injection of conbercept on neovascular glaucoma patients: a prospective, interventional case series study

“…BCVA was converted to the logarithm of the minimum angle of resolution (LogMAR), and IOP was measured with a Goldmann tonometer (AT 900, Haag-Strsit AG, Switzerland, Bern) except in patients with corneal oedema due to high IOP, in whom an Icare handheld rebound tonometer (TA01i, Finland Aike company, Finland, Helsinki) was used. Iris neovascularization grades were scored as follows: grade 1, surface neovascularization of the pupillary zone of the iris involving ≤2 quadrants; grade 2, surface neovascularization of the pupillary zone of the iris involving ≥2 quadrants; grade 3, neovascularization of the ciliary zone of the iris involving 1 to 3 quadrants in addition to the pupillary zone; and grade 4, neovascularization of the ciliary zone of the iris involving ≥3 quadrants [6].…”