Bevacizumab (Avastin) for the management of anterior chamber neovascularization and neovascular glaucoma

Abstract

Purpose: To establish the efficacy and safety of intravitreal bevacizumab in reducing iris and anterior chamber angle neovascularization and managing neovascular glaucoma.

Design: Prospective interventional case series.

Patient and methods: Eleven eyes of 11 patients with iris and anterior chamber angle neovascularization with refractory intraocular pressure were treated with intravitreal injection of 1.25 mg bevacizumab (Avastin((R))). The study group included eight males and three females aged 23 to 77 years (average, 62 years). Out of the 11 cases, five had proliferative diabetic retinopathy, of whom two had undergone vitrectomy for tractional retinal detachment and vitreous hemorrhage, and six were secondary to ischemic central retinal vein occlusion (CRVO). All patients were followed for eight to 16 months (average, 10 months).

Results: Iris and anterior chamber angle neovascularization receded in all eyes after one to three injections at monthly intervals. In five eyes, neovascularization recurred during the follow-up period. The intraocular pressure normalized in one eye. Four eyes were controlled with anti-glaucoma drops. A cyclodestructive procedure was required in two eyes. An Ahmet drainage valve was implanted in four eyes, including one controlled with additional antiglaucoma drops and one in which the intraocular pressure remained high while on maximum antiglaucoma medication and a cyclodestructive procedure was scheduled.

Conclusions: Bevacizumab appears to be effective in reducing iris and anterior chamber angle neovascularization and is likely to extend our therapeutic options in the management of neovascular glaucoma.

Keywords: Avastin®; anterior chamber angle neovascularization; bevacizumab; iris neovascularization; neovascular glaucoma.

Figure 1

Case 1 A) On presentation and B) after first injection. Regression of iris neovascularization.

Figure 2

Case 3 A) On presentation, iris neovascularization. After three-month intravitreal injections of bevacizumab neovascularization disappears. B) Reappearance of neovascularization six months later.