Efficacy and Safety of Intracameral Bevacizumab for Treatment of Neovascular Glaucoma

Abstract

Purpose: To evaluate the long-term efficacy and safety of intracameral bevacizumab in patients with neovascular glaucoma.

Methods: This retrospective study included 26 eyes of 26 neovascular glaucoma patients who received intracameral bevacizumab injection between January 2013 and May 2015, and were followed-up for at least 1 year. All patients were treated with topical and/or systemic intraocular pressure (IOP)-lowering medications, intracameral bevacizumab, and panretinal photocoagulation (PRP). The main outcome measures were changes in visual acuity, IOP, and neovascularization of the iris (NVI) and the anterior chamber angle (NVA). To assess the safety of intracameral bevacizumab, corneal endothelial changes were also determined using specular microscopy. Patients whose IOP was uncontrolled received IOP-lowering surgery. Clinical factors associated with IOP-lowering surgery were also investigated.

Results: In all patients, intracameral bevacizumab resulted in a rapid and marked reduction of IOP, NVI, and NVA within 1 week. At 12 months after initial injection, 19 of 26 eyes (73%) underwent IOP-lowering surgery. The average interval between initial injection and surgical treatment was 33.6 ± 26.9 days. Baseline IOP (p = 0.018), NVA grade (p = 0.029), and incomplete PRP (p = 0.005) were identified as predictive factors for IOP-lowering surgery. During the follow-up period, there were no statistically significant corneal endothelial changes after intracameral bevacizumab injection.

Conclusions: During 1 year of follow-up after intracameral bevacizumab, the procedure was found to be safe for the corneal endothelium. However, the IOP-lowering effect was transient, and 73% of patients eventually required IOP-lowering surgery. Predictive factors for IOP-lowering surgery were high baseline IOP and NVA grade, and incomplete PRP.

Keywords: Bevacizumab; Intracameral injection; Neovascular glaucoma; Vascular endothelial growth factor.

Fig. 1. The changes in intraocular pressure (IOP) after intracameral bevacizumab injection. Of 26 eyes, IOP in 22 eyes could be controlled with injection, but 4 eyes received anti-glaucoma surgery 1 week after injection. At 1 month, 14 eyes received the surgery, and the number increased to 19 eyes at 12 months after injection. IOP in the eyes of the non-surgical group was maintained <20 mmHg after treatment. The surgical group showed poor response to injection, but, after surgery IOP also stabilized.