Treatment of Neovascular Glaucoma after Proton Therapy for Uveal Melanomas with Ranibizumab Injection: Preliminary Results

Abstract

A last-chance intravitreal injection of ranibizumab was administered alone or in combination with cryotherapy before enucleation for 14 melanomas with neovascular glaucoma (NVG) after proton therapy. These patients were uncontrolled despite medical treatment and experienced pain. All of our patients had a minimum of 4 months of follow-up (ranging from 4 to 22 months). In all of the cases, the neovessels disappeared, and the intra-ocular pressure was normal for 11 out of the 14 patients with or without antiglaucoma drops. No patient experienced pain after the first injection. Tumour regression increased in some patients. However, thus far, the number of cases has been too small to perform any statistical analyses. Although very promising, our results are only preliminary.

Non-Cancer Effects following Ionizing Irradiation Involving the Eye and Orbit

“…The goal of anti-VEGF is either to stop the development of NVG or eliminate pain to avoid enucleation (30% of patients with NVG require enucleation). Anti-VEGF, administered either by intravitreal [ 118 , 119 ] or intracameral [ 120 ] injection, induces a regression of iris neovessels, but the vascular architecture remains, explaining the recurrence if the cause of NVG is not treated. Acting early allows the regression of iris neovessels before they invade the trabecula meshwork, avoiding an intra-ocular pressure (IOP) increase and the constitution of a fibrous neovascular membrane over the trabeculum.…”

Anti-vascular endothelial growth factor for neovascular glaucoma

“…Excluded studies-The 10 studies excluded after full text review were documented in the 'Characteristics of excluded studies' table. One study, a retrospective case series, evaluated ranibizumab (Caujolle 2012), while eight studies evaluated bevacizumab. The tenth study, an ongoing RCT, is evaluating a single injection of aflibercept followed by observation with injections of aflibercept at eight week intervals (NCT01711879).…”

“…Study Reason for exclusion Caujolle 2012 Retrospective, non-randomized study of ranibizumab injections with or without cryotherapy; 14 participants (14 eyes) previously treated with proton therapy for uveal melanomas with minimum of 4 months follow-up; no control group Costagliola 2008 Prospective pilot study of bevacizumab injections; 23 participants (26 eyes) received injections and were followed for 12 months; no control group Eid 2009 Historical cohort study of bevacizumab injections and aqueous shunting surgery; 20 participants with NVG received injections followed by surgery and were compared to a historical group of 10 participants treated with PRP and surgery without bevacizumab RCT of intracameral bevacizumab prior to undergoing MMC trabeculectomy; participants received either 1.25 mg injections (n = 9) or 2.5 mg injections (n = 10) and were followed for six months; there was no control group in which no intracameral bevacizumab was given; participants may have been treated previously with some form of conventional treatment (PRP, anterior retinal cryopexy) or no conventional treatment Historical cohort of non-randomized participants who did not receive intracameral bevacizumab injections; outcomes from 16 participants/eyes who had MMC trabeculectomy in years prior to the trial were compared with the outcomes from the trial participants…”

VEGF inhibitors in glaucoma surgery

“…J. Caujolle использовал интравитреальное введение рани-бизумаба в качестве монотерапии и в сочетании с циклокриотерапией в качестве альтернативы энуклеации на 14 глазах пациентов с НВГ и не-компенсированным на максимальном режиме дав-лении после протонной терапии. Во всех случаях удалось добиться регресса неоваскуляризации и в 11 случаях из 14 -нормализовать ВГД [7].…”