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

Abstract

We report three cases of neovascular glaucoma secondary to central retinal artery occlusion (CRAO) which were effectively managed with intravitreal bevacizumab (IVB) followed by panretinal photocoagulation (PRP). Neovascular glaucoma without peripheral anterior synechiae developed between one and five weeks following CRAO onset. All patients received 0.75 mg (0.03 ml) IVB. In all patients, complete regression of the iris and anterior chamber angle neovascularization was confirmed within one week. PRP was applied two weeks after the injection. The follow-up period was four to seven months (average, five months). Intraocular pressure was controlled in all patients using topical antiglaucoma medications alone. However, one patient experienced a recurrence of neovascularization three months after the initial combination treatment. This patient received another IVB injection and additional PRP, and the recurrent neovascularization resolved. There were no local or systemic adverse events in any patients. Therefore, intravitreal bevacizumab may be an effective adjunct in the treatment of neovascular glaucoma associated with CRAO.

Ocular neovascularization in eyes with a central retinal artery occlusion or a branch retinal artery occlusion

“…They stated that the timing of all three patients developing NVG after the CRAO, in addition to the patients having no signs of ONV prior to the CRAO, strongly suggests an association between NVG and CRAO. In addition, their three patients had no delay in filling on fluorescein angiogram 9. More recently, in 2010, Rudkin et al stated that they demonstrated a clear correlation and a “causal relationship” between CRAO and NVI based on the timing of the two entities.…”

“…Furthermore, the detection of ONV following CRAO has ranged from as early as the day of presentation to 2 years after the CRAO diagnosis 4,8. With frequent visits, many cases of ONV can be managed early with treatments such as panretinal photocoagulation and off-label intravitreal bevacizumab 9,11,12. Rudkin et al concluded that since ONV can occur early, regular follow-up appointments should be required, especially within the first 4 months 5…”

Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion

“…Our study demonstrated an incidence of NVI following acute CRAO of 10.9%. Previous studies have reported a prevalence of ocular NV post CRAO ranging from 3.0% to 28.2% [ 1 2 3 4 ]. Our result is within the range of previous reports.…”

“…The incidence is estimated to be 1.80 in 100,000 people [ 1 ]. CRAO can induce neovascularization of the iris (NVI) and neovascular glaucoma (NVG), with a reported incidence of 1% to 20% [ 2 ]. Neovascularization (NV) of the iris is a relatively rare complication observed in the setting of retinal ischemic disease, including proliferative diabetic retinopathy (PDR), ocular ischemic syndrome (OIS), or central retinal vein occlusion (CRVO).…”

Early Development of Two Neovascular Glaucoma Cases Following Central Retinal Artery Occlusion

“…13 Previous studies showed the success of intravitreally injected anti-VEGF molecule alone or in combination with panretinal laser for neovascularization regression. 14,15 Moreover, it is the first use of aflibercept with a single dose for treating the development of neovascularization after CRAO. To the best of our knowledge, this is the first report in the literature.…”