Outcome of intravitreal bevacizumab [avastin] followed by aqueous shunting tube surgery for management of intractable neovascular glaucoma

ABSTRACT

To study safety and efficacy of intravitreal Bevacizumab [IVB] injection followed by aqueous shunting tube surgery [ASTS] for management of neovascular glaucoma [NVG] with intractable high IOP. Twenty-five eyes of 25 patients with NVG and high IOP not responsive to maximally tolerated antiglaucoma medications were treated with ASTS [Ahmad valve]. Patients were classified into two groups; Group 1 [14 eyes] received IVB [1.25 mg/ 0.05ml] before ASTS. These eyes had severe retinopathy, florid NVI, dense cataract, or corneal edema that prevented proper panretinal photocoagulation [PRP] before glaucoma surgery. Group 2 [11 eyes] was treated by PRP followed by ASTS without IVB injection. Outcome measures included IOP reduction and operative complications. Mean preoperative IOP was 56.3 mmHg in group 1 and 53.3 mmHg in group 2 [p=0.8]. After IVB injection, NVI regressed markedly with media clarity and mild reduction of IOP [44.2 mmHg]. Average duration between IVB injection and ASTS was 12 days. IOP at last follow-up was 19.5 mmHg in group 1 and 17.6 mmHg in group 2 [p=0.5], with 5 eyes in group 1 and 4 eyes in group 2 on antiglaucoma drops. Post-ASTS complications were comparable between both groups. One eye in each group had one surgical intervention to treat postoperative complications. One eye in group 2 required additional glaucoma surgery. Intravitreal Bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in eyes with severe NVG and intractable IOP which cannot be treated preoperatively by PRP