Intravitreal bevacizumab (Avastin ® ) injection for neovascular glaucoma: a survey on 23 cases throughout 12‐month follow‐up

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Neovascular glaucoma (NVG) is a form of secondary glaucoma in which fibrovascular tissue grows, leading to progressive angle closure with elevation of intraocular pressure. • NVG is poorly responsive to the conventional treatment and has a poor visual prognosis. WHAT THIS STUDY ADDS • The present study, performed in 23 patients (26 eyes), shows that three intravitreal injections of bevacizumab scheduled at 4‐week intervals are able to result in significant regression of neovascularization, with best response achieved after the third injection. • Our study suggests that bevacizumab is effective in rapidly controlling neovascularization and in preventing angle closure. • Improvements are demonstrated to last at 12 months, and additional interest comes from the lack of any significant adverse effects. AIMS Neovascular glaucoma (NVG) represents one of the most severe forms of secondary glaucoma, caused by a number of ocular and systemic conditions, which share the common element of retinal ischaemia/hypoxia that initiates the subsequent release of angiogenesis factors, with consequent development of new abnormal vessels through the ciliary body. The aim was to examine the potential efficacy and safety of intravitreal injection of bevacizumab (IVB) (Avastin®) in the treatment of NVG in patients who had already undergone the standard retinal ablative procedure. METHODS This was a prospective pilot trial. Clinical data of 26 eyes from 23 patients, including diagnosis, visual acuity, iris fluorescein angiography stage and intraocular pressure (IOP), were collected. Three injections of bevacizumab were scheduled for each recruited eye at 4‐week intervals from the start. All investigations were repeated the day before the IVB (1.25 mg/0.05 ml) and at the 1‐, 3‐, 6‐, 9‐ and 12‐month follow‐up. RESULTS Regression of corneal oedema together with significant pain reduction was achieved in all eyes already after the first IVB, without any noteworthy improvement of visual acuity. At the end of the scheduled protocol (three IVB), regression of iris neovascularization was documented in all patients, together with significant improvement of visual acuity. The IOP reduction from baseline ranged from 30 to 0 mmHg (12.1 ± 8 mmHg). CONCLUSIONS Intravitreal bevacizumab, as adjunctive treatment to the standard retinal ablative procedure, seems promising for the management of conditions responsible of retinal ischaemia/hypoxia associated with NVG.