Intravitreal bevacizumab to treat iris neovascularization and neovascular glaucoma secondary to ischemic retinal diseases in 41 consecutive cases.
OBJECTIVE
To evaluate the biologic efficacy of intravitreal bevacizumab (IVB) for iris neovascularization (INV) or neovascular glaucoma (NVG) in patients with ischemic retinal disorders.


METHODS
Retrospective, consecutive, interventional case series.


METHODS
Thirty patients (41 eyes) with INV or NVG secondary to ischemic retinal disorders.


METHODS
Patients received IVB (1 mg) as the initial treatment for INV or NVG and were followed up for at least 6 months. Ophthalmic evaluations included measurement of visual acuity and intraocular pressure (IOP), a complete ophthalmic examination, and fluorescein angiography. Patients were divided into 3 subgroups: INV without elevated IOP (INV group), NVG with an open angle (O-NVG group), and NVG with angle closure (C-NVG group) for outcomes analysis.


METHODS
The controllability of IOP by IVB, incidence of recurrence, and requirement for surgery to treat NVG.


RESULTS
No significant ocular or systemic adverse events developed during follow-up (range, 6-22 months; mean, 13.3 months). The mean IOP levels were 14.7, 31.2, and 44.9 mmHg at baseline in the INV, O-NVG, and C-NVG groups, respectively. In the INV group (9 eyes), the INV regressed or resolved after 1 injection. Iris neovascularization recurred in 4 eyes by 6 months and stabilized after repeated injections without IOP elevation. In the O-NVG group (17 eyes), rapid neovascular regression with successful IOP normalization (<or=21 mmHg) occurred in 12 eyes (71%) within 1 week after 1 injection. Five (29%) of the 17 eyes required surgery by 6 months despite repeated IVB injections, and a total of 7 eyes (41%) underwent surgery during follow-up. In the C-NVG group (15 eyes), IVB caused INV resolution but failed to lower the IOP. Fourteen (93%) of 15 eyes required surgery by 2 months after initial IVB and achieved IOP stabilization. The mean interval between IVB and surgery was significantly shorter in the C-NVG group than in the O-NVG group (P<0.001).


CONCLUSIONS
Intravitreal bevacizumab is well tolerated, effectively stabilized INV activity, and controlled IOP in patients with INV alone and early-stage NVG without angle closure. In advanced NVG, IVB cannot control IOP but may be used adjunctively to improve subsequent surgical results. Further evaluation in controlled randomized studies is warranted.
Wakabayashi
Taku
T
Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan.
Oshima
Yusuke
Y
Sakaguchi
Hirokazu
H
Ikuno
Yasushi
Y
Miki
Atsuya
A
Gomi
Fumi
F
Otori
Yasumasa
Y
Kamei
Motohiro
M
Kusaka
Shunji
S
Tano
Yasuo
Y
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005260:Female; D005451:Fluorescein Angiography; D015355:Glaucoma, Neovascular / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects; D007498:Iris / Q000098:blood supply*; D007511:Ischemia / Q000150:complications*; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D012164:Retinal Diseases / Q000150:complications*; D012171:Retinal Vessels; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014794:Visual Fields; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab