Intraviteal Bevacizumab (Avastin®) Injection for the Treatment of Early-Stage Neovascular Glaucoma

Abstract

Purpose: This case is conducted to assess the short-term safety and efficacy of intravitreal bevacizumab injection in patient with early-stage of the neovascular glaucoma (NVG) without peripheral anterior synechiae. Case summary: A 66-year-old patient with a history of proliferative diabetic retinopathy presented with neovascularization of the iris and the angle and high intraocular pressure of 30 mmHg. The patient received a single injection of bevacizumab (1.25 mg /0.05 mg) intravitreally. The visual acuity (VA), intraocular pressure (IOP), regression of the iris and the angle neovascularization were measured up to the twenty ninth week after injection. Regression of the iris and angle neovascularization were confirmed from the second week after injection. The visual acuity had continued stable and the IOP had been controlled from 30 mmHg to 20 mmHg from fifth week without the need for topical antiglaucoma medications until the twenty ninth week. Conclusions: Bevacizumab may be an effective medication for the treatment of neovascular glaucoma. Bevacizumab seems to be a useful adjunct or an advantageous treatment option to panretinal photocoagulation in the treatment of neovascular glaucoma.

Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion

“… 18 Some studies have reported on the short-term efficacy and safety of off-label IVB in the treatment for NVI and NVG. 9 - 11 A marked regression of NVI has been shown to occur within one to two weeks after the injection. IOP was controlled for the short follow-up period in most patients, even those with early-stage NVG.…”

“…Some studies have reported on the short-term efficacy and safety of off-label IVB in the treatment for NVI and NVG 9-11. A marked regression of NVI has been shown to occur within one to two weeks after the injection.…”

“…There has only been one case report describing the utility of bevacizumab in one PRP-treated eye with a history of proliferative diabetic retinopathy. 11 We describe three cases of NVG following CRAO treated with combination IVB/PRP.…”

“…Intravitreal administration of bevacizumab (Avastin, Genentech, Inc., San Francisco, CA, USA), a recombinant anti-VEGF, has been reported to be beneficial in the treatment of NVG. In a review of the literature, we noted that bevacizumab causes early-onset neovascular regression in less than one week, and that regression of the NVI may persist for four to ten weeks because of its short duration lasting for four weeks 7-11. Given the chronic nature of the ischemic drive in NVG and the rapid decline of the effects of bevacizumab, a combination therapy of intravitreal bevacizumab (IVB) with early onset neovascular regression and PRP with a long duration of action might be useful in managing NVG 5,12.…”

Concentration of Vascular Endothelial Growth Factor After Intracameral Bevacizumab Injection in Eyes With Neovascular Glaucoma

“…Regression of the iris and angle of neovascularization were confirmed from the second week after injection. 15 …”