Serial aqueous VEGF analysis for predicting anti-VEGF treatment outcomes in neovascular glaucoma from diabetic retinopathy: a prospective analysis.

This study evaluated the clinical outcomes of intravitreal bevacizumab (IVB) in neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) and investigated the association between serial aqueous vascular endothelial growth factor (VEGF) levels and treatment outcomes. A prospective single-arm observational study included 17 patients with NVG due to PDR. All patients received three bi-weekly IVB injections. Aqueous VEGF levels, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured before and after each injection. After the initial three injections, additional IVB injections were administered on a pro re nata (PRN) basis if IOP exceeded 21 mmHg or if iris or angle neovascularization persisted or recurred. Patients were followed for up to 3 years. After three injections, mean VEGF levels significantly decreased from 4681.46 pg/mL to 104.55 pg/mL (P < 0.001). BCVA improved (1.27 to 0.91 LogMAR, P < 0.001), and IOP decreased from (32.71 to 25.29 mmHg, p = 0.031). Higher baseline VEGF levels were significantly associated with worse BCVA and elevated IOP after treatment, as well as more frequent injections. Patients requiring six or more injections showed significantly higher baseline VEGF levels and poorer clinical outcomes compared to those requiring five or fewer injections. Serial aqueous VEGF levels were significantly associated with clinical outcomes and treatment burden in NVG secondary to PDR. Aqueous VEGF may serve as a potential surrogate marker reflecting disease severity and therapeutic response.