Intravitreal bevacizumab for neovascular glaucoma: a randomized controlled trial

Abstract

Purpose: To determine the effect of intravitreal bevacizumab (IVB) on neovascular glaucoma (NVG) in terms of iris neovascularization (NVI), intraocular pressure (IOP), and visual acuity.

Methods: This randomized controlled trial included 26 eyes of 26 patients with NVG. All eyes received conventional treatment for NVG and were randomly allocated to three 2.5 mg IVB injections at 4-week intervals or a sham procedure (subconjunctival normal saline) at similar time intervals and in the same setting.

Results: Overall, 14 eyes of 14 patients received IVB and 12 eyes of 12 subjects were allocated to the sham procedure and followed for a mean period of 5.9+/-1.4 months. The IVB group demonstrated significant reduction in IOP from a baseline value of 33.4+/-14.5 mm Hg to 21.8+/-13.7 mm Hg (P=0.007), 25.1+/-20 mm Hg (P=0.058), and 23.9+/-18.7 mm Hg (P=0.047) at 1, 3, and 6 months after intervention, respectively. NVI was also significantly reduced from a mean baseline value of 347+/-48 degrees to 206+/-185 degrees (P=0.01), 180+/-187 degrees (P=0.004), and 180+/-180 degrees (P=0.004) at 1, 3, and 6 months after intervention. In contrast, IOP and NVI remained unchanged or increased insignificantly at all follow-up intervals in the control group. No significant change in visual acuity was observed within the study groups at any time interval. The study groups were comparable in terms of requirement for additional interventions such as panretinal photocoagulation and cyclodestructive procedures.

Conclusions: Intravitreal injections of bevacizumab seem to reduce NVI and IOP in NVG and may be considered as an adjunct to more definitive surgical procedures for NVG.