title: Intravitreal bevacizumab in refractory neovascular glaucoma: a prospective, observational case series.
abstract: OBJECTIVE
  To examine the efficacy of intravitreal bevacizumab for pain relief in eyes with refractory neovascular glaucoma.
  
  
  METHODS
  In this prospective case series, 52 eyes with neovascular glaucoma were administered intravitreal bevacizumab, 1.25 mg, and monitored for 6 months. The primary outcome measure was change in subjective pain score. Intraocular pressure and iris neovascularization were evaluated at each visit. Surgical intervention for control of intraocular pressure was performed according to clinical need.
  
  
  RESULTS
  Forty-two patients (44 eyes) completed the 6-month follow-up. Subjective pain score was reduced significantly 1 week after intravitreal bevacizumab injection and lasted throughout the follow-up period (median [interquartile range]: baseline, 3 [0-6]; week 1, 1 [0-3]; month 1, 0 [0-1]; month 3, 0 [0-1]; and month 6, 0 [0-0]; Kruskal-Wallis χ(2) 31.03; P < .001). A rapid, yet relatively transient, reduction in iris neovascularization was also noted (iris neovascularization grade at baseline, 4.0 [3-4]; week 1, 2.5 [1-4]; month 1, 2.0 [1-4]; month 3, 3.0 [2-4]; and month 6, 3.0 [2-4], χ(2) 23.33; P < .001). Four eyes (8%) required more than 1 injection to facilitate further intraocular surgery.
  
  
  CONCLUSIONS
  Intravitreal bevacizumab is a useful adjunct in the management of refractory neovascular glaucoma, producing rapid relief of pain. However, we found no evidence to suggest that intravitreal bevacizumab lowers intraocular pressure in eyes with angle closure; conventional medical, laser, and surgical treatment are still needed in these eyes.
authors.affiliation: Glaucoma Research Unit, Moorfields Eye Hospital, 162 City Road, London, England.
authors.forename: Aachal
authors.initials: A
authors.lastname: Kotecha
authors.forename: Alexander
authors.initials: A
authors.lastname: Spratt
authors.forename: Lola
authors.initials: L
authors.lastname: Ogunbowale
authors.forename: Roberto
authors.initials: R
authors.lastname: dell'Omo
authors.forename: Avinash
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Catey
authors.initials: C
authors.lastname: Bunce
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Franks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents / Q000008:administration & dosage; D000068258:Bevacizumab; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D058449:Intravitreal Injections; D007498:Iris / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D011446:Prospective Studies; D012008:Recurrence; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab