Intravitreal bevacizumab for treatment of neovascular glaucoma. Report of 20 cases

Background: Bevacizumab is a recombinant humanised monoclonal antibody directed against the vascular endothelial growth factor (VEGF). We report the results of bevacizumab injections in the treatment of 20 cases of neovascular glaucoma.

Methods: Seven women and 13 men, of average age 73 years old, presented with neovascular glaucoma secondary to central retinal vein occlusion in 8 cases, proliferative diabetic retinopathy in 8 cases, central retinal artery occlusion in 2 cases, radiation retinopathy in 1 case and ocular ischemic syndrome in 1 case. Iris fluorescein angiography was performed before and two days after 2,5 mg intravitreal bevacizumab. Diode laser cyclophotocoagulation was realised in 12 cases of grade 4 neovascular glaucoma in the week following the injection. Panretinal photocoagulation was conducted in all cases.

Results: After a 4 months and a half follow up, iris angiography revealed dramatic regression of iris neovascularisation in a few days. In grade 2 and 3 neovascular glaucoma, the single injection is sufficient to control intraocular pressure. In grade 4 neovascular glaucoma, intraocular pressure was controlled in 87,5 % of cases with one injection and one or more diode laser cyclophotocoagulation.

Conclusions: The antiangiogenic effect of bevacizumab leads to fast reduction of the iris neovascularization with control of intraocular pressure without any surgery in grade 2 or 3 neovascular glaucoma. Panretinal photocoagulation was facilitated by improvement of corneal swelling. Diode laser cyclophotocoagulation was necessary in grade 4. Conclusions: Intravitreal bevacizumab was effective in reversing iris neovascularization in association with panretinal photocoagulation and cyclophotocoagulation.