Intravitreal Bevacizumab in Refractory Neovascular Glaucoma

Kotecha, Aachal; Spratt, Alexander; Ogunbowale, Lola; dell’Omo, Roberto; Kulkarni, Avinash; Bunce, Catey; Franks, Wendy

doi:10.1001/archophthalmol.2010.350

Cited by 34 publications

(33 citation statements)

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“…23 We have observed by slit lamp examination and by iris angiography that iris neovascularization is completely regressed within 3 days of intravitreal bevacizumab injection. However, bevacizumab, although rapidly-acting, induces temporary antiangiogenic effects with recurrence of neovascularization, 28,33 due to its short duration of action. 34,35 On the other hand, the effects of PRP appear to be more long lasting, suggesting that eyes with NVG can benefit from both the early-onset Figure 1 (a) Kaplan-Meier Survival Analysis of NVG Eyes Receiving GDIs.…”

Section: Discussionmentioning

confidence: 99%

“…Case series and retrospective studies have reported only short-term reduction in neovascularization, inflammation and IOP in eyes receiving anti-VEGF agents. 24,28,30,33,36,[42][43][44][45] A systematic review of literature in 2013 concluded that no compelling evidence exists from which reliable conclusions could be drawn comparing the effects of anti-VEGF agents either alone or as an adjunctive modality to other forms of treatment but no anti-VEGF agents in NVG. 46 The review identified two RCTs evaluating intravitreal bevacizumab injection in NVG.…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Olmos

Sayed

Moraczewski

et al. 2015

Eye

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Olmos

Sayed

Moraczewski

et al. 2015

Eye

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“…[6][7][8][9] In a previous paper published by our group and entitled 'Outcomes of treatment of neovascular glaucoma with intravitreal bevacizumab', Kaplan-Meier analysis in Figure 3 10 revealed a linear increase in the cumulative proportion of NVG eyes receiving a second IVB injection with time. The reason for repeated injections was most likely recurrent or persistent NVI and/or neovascularization of anterior chamber angle.…”

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confidence: 87%

Reply to ‘Comment on: Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab’

Olmos

Sayed

Lee

2016

Eye

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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.

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“…12 Additional intravitreal anti-VEGF has also been shown to be a useful adjunct in producing rapid pain relief in refractory neovascular glaucoma. 13 Long-term outcomes and the prognosis of eyes treated with the latest approaches in the management of neovascular glaucoma are lacking from recent literature. However, the addition of intravitreal anti-VEGF has revolutionised the treatment of neovascular glaucoma, and in combination with early detection, thorough pan-retinal photocoagulation and safe surgical intervention should result in long-lasting maintenance of visual functional and acceptable IOP control.…”

Section: Table 1: Clinical Experiencesmentioning

confidence: 99%

Reversing the Rubeotic Rampage – Current Approaches in the Management of Neovascular Glaucoma

Rodrigues¹,

Ks²

2016

European Ophthalmic Review

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Neovascular glaucoma is a sight-threatening condition, and can rapidly progress from rubeosis with normal intraocular pressure (IOP), to secondary open-angle glaucoma with raised IOP and finally secondary angle-closure glaucoma with uncontrolled IOP. Early detection and aggressive management with panretinal photocoagulation, intravitreal anti-vascular endothelial growth factor (VEGF), topical aqueous suppressants and valved glaucoma drainage surgery can reduce risk of significant visual loss secondary to neovascular glaucoma. This editorial explores some simple measures that can increase surgical success rates and minimise complications. KeywordsNeovascular glaucoma, rubeosis, anti-vascular endothelial growth factor, tube surgery Disclosure: Ian A Rodrigues and K Sheng Lim have no disclosures or conflicts of interest relevant to this article to declare. No funding was received in the publication of this article. This article is a short opinion piece and has not been submitted to external peer reviewers but was reviewed by the advisory board before publication.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit.

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Intravitreal Bevacizumab in Refractory Neovascular Glaucoma

Cited by 34 publications

References 50 publications

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Reply to ‘Comment on: Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab’

Reversing the Rubeotic Rampage – Current Approaches in the Management of Neovascular Glaucoma

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