Intravitreal bevacizumab with or without mitomycin C trabeculectomy in the treatment of neovascular glaucoma

Hatem M Marey, Amin F Ellakwa
Department of Ophthalmology, Faculty of Medicine, Menoufiya University, Shibin el Kom, Egypt

Purpose: To demonstrate the role of intravitreal bevacizumab in regression of iris neovascularization, and intraocular pressure (IOP) control in neovascular glaucoma.
Methods: A retrospective random case series study was performed. Twenty eyes of 20 patients who presented with neovascular glaucoma were treated with intravitreal bevacizumab 2.5 mg in 0.1 mL. Retinal photocoagulation was performed for all cases as soon as possible after intravitreal injection and subscleral trabeculectomy with mitomycin C 0.4 mg/mL for 3 minutes for cases having peripheral anterior synechiae. Cases were followed up for 12 months when regression of iris neovessels, IOP control, improvement in visual acuity, and success of filtering surgery were recorded.
Results: All cases showed complete regression of iris neovessels at 2 months after injection; recurrence of iris neovessels was observed in 4 cases (20%) at 4 months and in 14 cases (70%) at 8 months follow-up. The mean IOP dropped from 41.45 ± 5.89 mmHg preoperatively, to 19.3 ± 5.5 mmHg and 17.75 ± 3.74 mmHg at 6 months and 12 months postoperatively, respectively. The success rate of subscleral trabeculectomy with mitomycin C after intravitreal bevacizumab was 77.8%. Visual acuity was improved in 17 cases (85%) from preoperative 0.12 ± 0.11 to 0.26 ± 0.2 postoperative.
Conclusion: Intravitreal bevacizumab has a role in regression of iris neovessels and IOP control in neovascular glaucoma cases and also in increasing the success rate of subscleral trabeculectomy with mitomycin C; however this role has a limited time and reinjection is needed to maintain this effect.

Keywords: bevacizumab, intravitreal injection, mitomycin C, neovascular glaucoma, subscleral trabeculectomy