Anterior segment changes following intravitreal bevacizumab injection for treatment of neovascular glaucoma

MI Canut¹, A Alvarez², J Nadal³, R Abreu⁴, JA Abreu⁵, JS Pulido^6
1Glaucoma Section, ²Barraquer Ophthalmology Centre, ³Retina and Vitreous Unit, Macula Section, Institut Universitari Barraquer, Universidad Autonoma de Barcelona, Barcelona, Spain; ⁴Retina and Vitreous Unit, University Hospital of La Candelaria, Tenerife ⁵Glaucoma Section, University Hospital of the Canary Islands, Tenerife, Spain; ⁶Retina and Vitreous Unit, Ophthalmology Department, Mayo Clinic, Rochester, MN, USA

Background: The purpose of this study was to describe anterior segment changes in a prospective, interventional, noncomparative case series of patients with neovascular glaucoma secondary to proliferative diabetic retinopathy treated with intravitreal bevacizumab.
Methods: Five consecutive patients with neovascular glaucoma and a refractory, symptomatic elevation of intraocular pressure and pronounced anterior segment congestion received intravitreal bevacizumab 1.25 mg/0.05 mL. Follow-up examinations were performed at 4–16 weeks by the same specialists, with testing performed at hour 48, week 1, and months 1, 3, and 6 after intravitreal bevacizumab.
Results: We observed a significant difference (P = 0.021) between initial and mean neovascularization at three months in all the quadrants. At three months, median intraocular pressure was 19 ± 5.38 (range 12–26) mmHg. In three of the five cases, diode laser cyclophotocoagulation was required, and in one case a trabeculectomy was performed. One patient showed complete synechial angle closure 48 hours after treatment which required cyclodestructive procedures to normalize intraocular pressure.
Conclusion: Intravitreal bevacizumab achieves complete regression of neovascularization in neovascular glaucoma secondary to proliferative diabetic retinopathy, and this regression is stable when associated with treatment of the underlying disease and should be investigated more thoroughly as an adjunct in the management of neovascular glaucoma.

Keywords: rubeosis, neovascular, glaucoma, bevacizumab, Avastin^®, intravitreal, angle closure, complications