Clinical factors related to recurrence of anterior segment neovascularization after treatment including intravitreal bevacizumab.
OBJECTIVE
To investigate the impact of clinical factors on the recurrence of anterior segment neovascularization after intravitreal bevacizumab injection.


METHODS
Retrospective, consecutive, interventional case series.


METHODS
Charts of 54 eyes of 54 consecutive patients who received intravitreal bevacizumab injections (1.25 mg) for the treatment of anterior segment neovascularization were reviewed. The mean follow-up period +/- standard deviation was 16 +/- 8 months (range, 4 to 31 months). For eyes with incomplete panretinal photocoagulation, additional retinal ablation was performed within 1 month after bevacizumab injection. Differences in clinical factors were compared between eyes with and without recurrence. Baseline clinical factors were age, gender, predisposing diagnosis, status and clinical stages of anterior segment neovascularization, fundus neovascularization, visual acuity, baseline intraocular pressure, previous retinal ablation, previous intraocular surgeries, lens status, history of glaucoma, hemoglobin A1c level, hypertension, and creatinine level. Factors after intravitreal bevacizumab administration were additional retinal ablation, intraocular surgeries, mean intraocular pressure until recurrence, and visual acuity. Univariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the contribution of these factors to recurrence. Kaplan-Meier survival analysis with the log-rank test was performed with recurrence as the end point.


RESULTS
Recurrence occurred in 26 (48%) eyes a mean +/- standard deviation of 4.7 +/- 3.0 months (range, 2 to 11 months) after bevacizumab injection. Multivariate analysis identified trabeculectomy after bevacizumab injection as the primary inhibitory factor for recurrence (hazard ratio, 0.23; 95% confidence interval, 0.094 to 0.55; P = .001). Kaplan-Meier survival analysis showed that trabeculectomy after bevacizumab injection provided a significantly better survival rate (P < .001).


CONCLUSIONS
Recurrence of anterior segment neovascularization after intravitreal bevacizumab injection occurs despite intensive retinal ablation: trabeculectomy may suppress recurrence.
Saito
Yoshiaki
Y
Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Higashide
Tomomi
T
Takeda
Hisashi
H
Murotani
Eiji
E
Ohkubo
Shinji
S
Sugiyama
Kazuhisa
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000869:Anterior Eye Segment / Q000098:blood supply*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000209:etiology* / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab