The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma

Ling Bai,Shu Zhang,Wenjing Wang,Farheen Tariq,Xindi Liu,Na He,Yanfen Wang,Feng Wang,Yuping Zheng

doi:10.3389/fmed.2021.766032

Abstract

This study investigates the safety and efficacy of conbercept injection through different routes for neovascular glaucoma (NVG) treatment, in which seventy-four patients (81 eyes) with NVG caused by ischemia retinopathy had participated. Patients were divided into three stages according to the progression of NVG and were randomly assigned to receive intracameral or intravitreal conbercept injection. After conbercept injection, patients experienced improved best-corrected visual acuity (BCVA), good intraocular pressure (IOP) control, and neovascularization of Iris (NVI) regression. In stage III, patients required trabeculectomy with mitomycin C plus pan-retinal photocoagulation (PRP) to achieve complete NVI regression. Compared to the intravitreal group, the intracameral group had significantly lower IOP in 2 days in stage III and 1 day in stages I and II after injection, complete NVI regression before PRP in stages I and II, and better NVI regression in stage III. The rates of hyphema after trabeculectomy and malfunction filtering bleb suffering needle bleb revision were lower in the intracameral group, but only the hyphema rate was significantly different. Injections through different routes are all safe. We recommend intravitreal injections for patients in stages I and II, but for stage III, intracameral injection is better, and trabeculectomy with mitomycin C should be conducted within 2 days after injection to maximally reduce the risk of perioperative hyphema.Trial Registration: ClinicalTrials.gov, identifier NCT03154892.

Highlights

Neovascular glaucoma (NVG) is a refractory type of secondary glaucoma and often leads to frustrating treatment and blindness
Pan-retinal photocoagulation is currently regarded as the gold standard treatment for NVG
pan-retinal photocoagulation (PRP) does not result in rapid regression of neovascularization of Iris (NVI)/NVA, which usually takes several weeks to occur

Summary

Introduction

Neovascular glaucoma (NVG) is a refractory type of secondary glaucoma and often leads to frustrating treatment and blindness. Conventional anti-glaucoma medicines cannot effectively reduce intraocular pressure (IOP) in NVG, and filtering surgery of anti-glaucoma often fails due to severe inflammation and perioperative hyphema. Cyclodestructive surgery, such as cyclophotocoagulation (CPC) and cyclocryotherapy, can decrease IOP. Open-angle glaucoma: Fibrovascular tissue grows over the trabecular meshwork and obstructs aqueous outflow. Patients have increased IOP, but the angle is open in various regions. Closed-angle glaucoma: Contraction of fibrovascular membrane produces secondary synechia of the trabecular meshwork and peripheral iris. Patients suffer from severe pain, abruptly high IOP, and often disastrous vision loss [2]

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