Efficacy of intravitreal Bevacizumab combined with trabeculectomy and panretinal photocoagulation in the management of neovascular glaucoma

Abstract

Objective To evaluate the long-term efficacy of intravitreal Bevacizumab (IVB) combined with trabeculectomy and panretinal photocoagulation (PRP) in the management of neovascular glaucoma.Methods It was a retrospective case series study.Eighteen eyes of 17 patients with neovascular glaucoma were included.Patients first received an intravitreal injection of Bevacizumab (1.25 mg in 0.05 ml).Trabeculectomy with intraoperative mitomycin C was then performed after the complete regression of neovascularization of the iris (NVI).PRP or supplementary photocoagulation was performed postoperatively.Compare the intraocular pressure (IOP) pre-IVB,pre-trabeculectomy and 1 week,1 month,3 months,6 months,12 months after trabeculectomy and the final visit.In addition,pre-IVB visual acuity (VA) was compared to VA at the final visit.The follow-up period ranged from 12 to 32 months,mean 20.5±7.4 months.Data were analyzed with paired t test and one-way ANOVA.Results NVI completely regressed in 18 of the eyes after IVB.The mean time for regression was 3.7±1.4 days (range from 2 to 7 days).Pre-IVB mean IOP was 51.9±10.9 mmHg,with 3.9±0.7 anti-glaucoma medications,and the mean logMAR VA was 2.26±0.43.Mean IOPs were 45.2±7.1,8.6±2.1,13.9±6.3,16.5±6.9,17.7±7.2,19.2±7.8,16.1±3.7 mmHg before trabeculectomy and at postoperative 1 week,1 month,3 months,6 months,12 months and the final visit,respectively.The reduction between pre-trabeculectomy IOP and pre-IVB IOP was statistically significant (t=5.437,P＜0.05).The reduction between post-trabeculectomy IOPs and pre-trabeculectomy IOP was statistically significant (F=64.79,P＜0.05).At the final visit,only 3 eyes were using anti-glaucoma medications,and the mean LogMAR VA was 2.1±0.6.The change in the mean LogMAR VA was not statisticallysignificant.Recurrence of NVI occurred in 4 eyes,two of which received ciliary photocoagulation.The complete success,qualified success and failure at the final visit was 13 eyes,3 eyes and 2 eyes,respectively.Conclusion IVB combined with trabeculectomy and PRP is an effective method for controlling intraocular pressure in NVG over the long term. Key words: Glaucoma,neovascular; Bevacizumab; Light coagulation,panretinal; Trabeculectomy