In Vivo Corneal Endothelial Safety of Intracameral Bevacizumab and Effect in Neovascular Glaucoma Combined With Ahmed Valve Implantation

Abstract

To evaluate the corneal toxicity of intracameral bevacizumab in rabbit eyes and also the effects of intracameral bevacizumab in neovascular glaucoma patients combined with Ahmed glaucoma valve implantation. Intracameral bevacizumab (1.25 mg/0.05 mL) was injected into 5 eyes of 5 New Zealand white rabbits. A balanced salt solution (0.05 mL) was injected intracamerally in another 5 rabbits as a control. The corneal thickness, endothelial cell counts, and intraocular pressure were measured before and at 1, 2, and 4 weeks after the intracameral injection of bevacizumab and a balanced salt solution. Scanning electron microscopic examinations were performed at 1 and 4 weeks after injection. In the clinical cases, 6 patients who received an intracameral injection of bevacizumab (1.25 mg) and Ahmed glaucoma valve implantation were enrolled. The visual acuity, intraocular pressure, and regression of iris rubeosis by iris fluorescein angiography were recorded before and at 1 week, 1 month, and 2 months after the intracameral bevacizumab injection and Ahmed glaucoma valve implantation. No morphologic and functional changes in the corneal endothelial cells were observed in the rabbit eyes after the intracameral bevacizumab and balanced salt solution injections. Iris rubeosis regression was observed in all eyes within 1 week after the injection. The visual acuity remained stable or improved, and the intraocular pressure was controlled in all eyes throughout the follow-up period. There were no ocular and systemic complications associated with the combined procedure. An intracameral injection of bevacizumab may be a safe alternative treatment for iris rubeosis in neovascular glaucoma when combined with Ahmed glaucoma valve implantation.