title: Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma--results from a prospective interventional case series.
abstract: BACKGROUND
  To evaluate the capability of adjuvant intraocular ranibizumab (Lucentis) injections in the treatment of rubeosis and intraocular pressure in patients with rubeosis and neovascular glaucoma.
  
  
  METHODS
  Ten eyes with rubeosis (R) and ten eyes with neovascular glaucoma (NVG) received Lucentis injections (ranibizumab 0.5 mg/0.05 ml) in this prospective, monocenter, 12-months, interventional case series. The primary efficacy outcome measure was the change of degree of iris rubeosis as documented by iris fluorescein angiography measured after 12 months. Secondary outcomes were intraocular pressure (IOP), best-corrected visual acuity (BCVA, logMAR), numbers of additional interventions or antiglaucoma medications administered after injection, the gonioscopic status of the anterior chamber angle, and central retinal thickness.
  
  
  RESULTS
  In the R group, 3.6 injections and in the NVG group 2.3 injections of Lucentis were administered. Additional treatments were photocoagulation (n = 19), cyclodestructive procedures (n = 9), cryopexy (n = 3), and vitrectomy (n = 1). The mean stage of rubeosis was 3.4 ± 0.7 in the R group and 3.6 ± 0.8 in the NVG group at baseline. At month 12, the rubeosis was almost resolved in the R group (0.1 ± 0.3, p < 0.001), and decreased significantly in the NVG group (0.7 ± 1.1, p < 0.001). In the NVG subgroup, mean IOP was 41.4 ± 13.4 mmHg at baseline, which decreased rapidly (18.2 ± 12.3, day-14, p = 0.005) and stabilized during the follow-up (15.6 ± 2.0 mmHg, p < 0.05). BCVA improved significantly in both groups (p < 0.05, at month 12).
  
  
  CONCLUSIONS
  Injection of 0.5 mg ranibizumab appears to be beneficial as an adjuvant treatment in neovascular glaucoma and rubeosis due to its anti-angiogenic properties and its ability to prevent establishment or progression of anterior chamber angle obstruction. Conventional therapeutic procedures addressing the retinal ischemia are still required in a stage-wise treatment approach.
authors.affiliation: Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany, julia.lueke@uk-sh.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Lüke
authors.forename: Khaled
authors.initials: K
authors.lastname: Nassar
authors.forename: Matthias
authors.initials: M
authors.lastname: Lüke
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D015590:Fluorophotometry; D015355:Glaucoma, Neovascular / Q000175:diagnosis / Q000188:drug therapy*; D006068:Gonioscopy; D006801:Humans; D056965:Injections, Intraocular; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D007498:Iris / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000188:drug therapy; D011446:Prospective Studies; D000069579:Ranibizumab; D014065:Tonometry, Ocular; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab
references.citation: Ophthalmology. 1984 Apr;91(4):321-5
references.pmid: 6201792
references.citation: Ophthalmology. 2012 Jul;119(7):1388-98
references.pmid: 22555112
references.citation: Ophthalmic Surg Lasers Imaging. 2006 Mar-Apr;37(2):144-6
references.pmid: 16583637
references.citation: Am J Ophthalmol. 2009 Feb;147(2):298-306
references.pmid: 18929354
references.citation: J Exp Med. 2003 Aug 4;198(3):483-9
references.pmid: 12900522
references.citation: Acta Ophthalmol Scand. 2006 Aug;84(4):556-7
references.pmid: 16879583
references.citation: Retina. 2008 May;28(5):696-702
references.pmid: 18463512
references.citation: Retina. 2006 Mar;26(3):352-4
references.pmid: 16508438
references.citation: Retina. 2006 Sep;26(7):839-41
references.pmid: 16963866
references.citation: Diabetes Care. 2010 Nov;33(11):2399-405
references.pmid: 20980427
references.citation: Am J Ophthalmol. 2010 Sep;150(3):315-324.e1
references.pmid: 20598667
references.citation: Ophthalmology. 2010 Dec;117(12):2387-2394.e1-5
references.pmid: 20630595
references.citation: Nat Rev Drug Discov. 2004 May;3(5):391-400
references.pmid: 15136787
references.citation: Ophthalmology. 2008 Sep;115(9):1571-80, 1580.e1-3
references.pmid: 18440643
references.citation: Ophthalmology. 2010 Jun;117(6):1124-1133.e1
references.pmid: 20381871
references.citation: J Glaucoma. 2007 Aug;16(5):437-9
references.pmid: 17700285
references.citation: Klin Monbl Augenheilkd. 2005 May;222(5):390-5
references.pmid: 15912456
references.citation: Am J Ophthalmol. 2006 Jul;142(1):158-60
references.pmid: 16815268
references.citation: Retina. 2006 Mar;26(3):354-6
references.pmid: 16508439
references.citation: Am J Ophthalmol. 2006 Dec;142(6):1054-6
references.pmid: 17157590
references.citation: Ophthalmology. 2010 Jun;117(6):1102-1112.e1
references.pmid: 20398941
references.citation: Invest Ophthalmol Vis Sci. 2007 Apr;48(4):1773-81
references.pmid: 17389511
references.citation: Am J Ophthalmol. 2010 Sep;150(3):310-4
references.pmid: 20591399
references.citation: Ophthalmology. 2011 Apr;118(4):615-25
references.pmid: 21459215