Elsevier

Ophthalmology

Volume 115, Issue 9, September 2008, Pages 1571-1580.e3
Ophthalmology

Original article
Intravitreal Bevacizumab to Treat Iris Neovascularization and Neovascular Glaucoma Secondary to Ischemic Retinal Diseases in 41 Consecutive Cases

Presented in part at: American Academy of Ophthalmology Annual Meeting, November 2007, New Orleans, Louisiana.
https://doi.org/10.1016/j.ophtha.2008.02.026Get rights and content

Purpose

To evaluate the biologic efficacy of intravitreal bevacizumab (IVB) for iris neovascularization (INV) or neovascular glaucoma (NVG) in patients with ischemic retinal disorders.

Design

Retrospective, consecutive, interventional case series.

Participants

Thirty patients (41 eyes) with INV or NVG secondary to ischemic retinal disorders.

Methods

Patients received IVB (1 mg) as the initial treatment for INV or NVG and were followed up for at least 6 months. Ophthalmic evaluations included measurement of visual acuity and intraocular pressure (IOP), a complete ophthalmic examination, and fluorescein angiography. Patients were divided into 3 subgroups: INV without elevated IOP (INV group), NVG with an open angle (O-NVG group), and NVG with angle closure (C-NVG group) for outcomes analysis.

Main Outcome Measures

The controllability of IOP by IVB, incidence of recurrence, and requirement for surgery to treat NVG.

Results

No significant ocular or systemic adverse events developed during follow-up (range, 6–22 months; mean, 13.3 months). The mean IOP levels were 14.7, 31.2, and 44.9 mmHg at baseline in the INV, O-NVG, and C-NVG groups, respectively. In the INV group (9 eyes), the INV regressed or resolved after 1 injection. Iris neovascularization recurred in 4 eyes by 6 months and stabilized after repeated injections without IOP elevation. In the O-NVG group (17 eyes), rapid neovascular regression with successful IOP normalization (≤21 mmHg) occurred in 12 eyes (71%) within 1 week after 1 injection. Five (29%) of the 17 eyes required surgery by 6 months despite repeated IVB injections, and a total of 7 eyes (41%) underwent surgery during follow-up. In the C-NVG group (15 eyes), IVB caused INV resolution but failed to lower the IOP. Fourteen (93%) of 15 eyes required surgery by 2 months after initial IVB and achieved IOP stabilization. The mean interval between IVB and surgery was significantly shorter in the C-NVG group than in the O-NVG group (P<0.001).

Conclusions

Intravitreal bevacizumab is well tolerated, effectively stabilized INV activity, and controlled IOP in patients with INV alone and early-stage NVG without angle closure. In advanced NVG, IVB cannot control IOP but may be used adjunctively to improve subsequent surgical results. Further evaluation in controlled randomized studies is warranted.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

The authors retrospectively reviewed the charts of a consecutive series of 41 eyes of 30 patients who underwent IVB to treat INV (IOP ≤21 mmHg without antiglaucoma medication) or NVG (IOP >21 mmHg) caused by ischemic retinal disorders including PDR, central retinal vein occlusion, and ocular ischemic syndrome. All patients were treated at the Department of Ophthalmology, Osaka University Hospital, Osaka, Japan, from October 2005 to June 2007 and were followed up for at least 6 months.

Results

Of the 30 patients, 7 were women and 23 were men. The mean age was 57.3±9.6 years (range, 34–71 years). The mean follow-up period was 13.3±5.1 months (range, 6–22 months). Of 41 eyes, 9 eyes were included in the INV group, 17 eyes in the O-NVG group, and 15 eyes in the C-NVG group. The patient demographics and baseline characteristics of each group are shown in Table 1. There was no significant difference in age, gender, the type of underlying ischemic retinal disease, previous treatments, lens

Discussion

Recent encouraging results from several small case studies of IVB in the treatment of INV, NVG, or both promoted the authors to consider the drug as the first treatment of choice not only for INV but also for more severe NVG secondary to ischemic retinal disorders.22 The rapid biologic effect of bevacizumab is favorable and is not surprising because preclinical primate studies have shown that intravitreal VEGF antibodies are sufficient to halt the experimentally induced INV by vein occlusion.4,

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  • Cited by (0)

    Manuscript no. 2007-1380.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

    Supported in part by research grants from the Ministry of Education, Science and Culture, Tokyo, Japan.

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