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

Abstract

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.

Effect of Preoperative Intravitreal Bevacizumab on the Surgical Outcome of Neovascular Glaucoma at Different Stages

“…From the beginning of the study, we focused on the effect of IVB on different stages of NVG, so detailed information of angle status before AGV implantation was required. Additionally, retrospective chart review did not reveal patients with NVG who were excluded from IVB before AGV implantation for any reason, similar to a previous study [5]. Further, angle status after IVB injection and/or AGV implantation was not assessed due to lack of information on chart.…”

Neovascular glaucoma: a review

“…They also had less postoperative complications and lower failure ratio than Ahmed surgery. However, in a recent study conducted by Olmos et al [60] intravitreal injection of bevacizumab was not superior than panretinal photocoagulation. The study was a retrospective, comparative, case series of 163 eyes of 151 patients with NVG, including 99 treated without and 64 treated with intravitreal bevacizumab.…”

Surgical Management and Techniques

“…If the media is clear, NVG can often be managed with intravitreal anti-VEGF agents combined with PRP and glaucoma surgery [45] . Topical cycloplegic, anti-glaucoma, and steroid medications (if not contraindicated) are also initiated.…”