www.diabeticretinopathy.org.uk

Research supporting Avastin use in rubeotic glaucoma

 

David Kinshuck

abbreviations

  • VEGF = vascular endothelial growth factor
  • IVA  = Intravitreal Avastin
  • ARMD = age-related macular degeneration
  • IVT in United States may be an abbreviation for intravitreal treatment, not intravitreal triamcinolone as on this website.

 

 

Kelkar AS, Kelkar SB, Kelkar JA, Nagpal M, Patil SP.
The use of intravitreal bevacizumab in neovascular glaucoma: a case report.
Bull Soc Belge Ophtalmol. 2007;(303):43-5.
Rapid improvement of retinal and iris neovascularization after a single intravitreal bevacizumab injection in a patient with central retinal vein occlusion and neovascular glaucoma.
Int Ophthalmol. 2008 Feb;28(1):59-61. Epub 2007 Jul 4.

Mason JO 3rd, Albert MA Jr, Mays A, Vail R.
Regression of neovascular iris vessels by intravitreal injection of bevacizumab.
Retina. 2006 Sep;26(7):839-41. No abstract available.

Silva Paula J, Jorge R, Alves Costa R, Rodrigues Mde L, Scott IU.
Short-term results of intravitreal bevacizumab (Avastin) on anterior segment neovascularization in neovascular glaucoma

Related Articles, Links
Oshima Y, Sakaguchi H, Gomi F, Tano Y.
Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy.

PURPOSE: To assess the short-term safety and efficacy of intravitreal injection of bevacizumab for iris neovascularization (INV). DESIGN: Noncomparative, interventional case series. METHODS: Intravitreal bevacizumab was injected in seven eyes of five patients with INV that was associated with proliferative diabetic retinopathy (PDR). The main outcome measurements were visual acuity, intraocular pressure (IOP), and regression of INV by fluorescein angiography before and one week, one month, and two months after injection. RESULTS: Regression of INV was confirmed in all eyes (100%) from one week after injection. Repeated injections stabilized the recurrence (two eyes; 29%) that was observed two months after the initial injection. The visual acuity remained stable or improved, and the intraocular pressure was controlled in six eyes (86%) throughout the follow-up period. No inflammation or complications were observed.
CONCLUSIONS: Intravitreal injection of bevacizumab may be an effective and safe alternative for patients with INV that is refractory to conventional treatments. 23 patients so far

Cashwell LF, Marks WP.
Panretinal photocoagulation in the management of neovascular glaucoma.
South Med J. 1988 Nov;81(11):1364-8.
We report a retrospective evaluation of the role of panretinal photocoagulation in the primary treatment of neovascular glaucoma. Thirty-six eyes (32 patients) received aggressive argon laser panretinal photocoagulation beginning as soon as feasible after diagnosis of the developing neovascular glaucoma. Thirty eyes were stabilized by photocoagulation, though 25 required long-term glaucoma medications. Six eyes required additional procedures. Vision deteriorated in 21 of the 36 eyes (nine eyes finally having "no light perception") during the 32.8-month follow-up. Intraocular pressure averaged 39.0 mm Hg before photocoagulation and 21.2 mm Hg at study's end. All 36 eyes were retained and remain comfortable. We conclude that panretinal photocoagulation plays an important role in the management of neovascular glaucoma.

Iliev ME, Domig D, Wolf-Schnurrbursch U, Wolf S, Sarra GM.
Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma.
Am J Ophthalmol. 2006 Dec;142(6):1054-6. Epub 2006 Aug 2.
PURPOSE: To describe a case series of neovascular glaucoma (NVG) caused by central retinal vein occlusion (CRVO) that was treated with intravitreal bevacizumab (IVB; Avastin). DESIGN: Retrospective interventional case series. METHODS: Six consecutive patients with NVG and a refractory, symptomatic elevation of intraocular pressure (IOP) and pronounced anterior segment congestion received IVB (1.25 mg/0.05 ml). Diode laser cyclophotocoagulation was carried out only if pressure was controlled insufficiently by topical medication. Follow-up examinations occurred at four to 16 weeks. RESULTS: IVB resulted in a marked regression of anterior segment neovascularization and relief of symptoms within 48 hours. IOP decreased substantially in three eyes; in the other three eyes, adjuvant cyclophotocoagulation was necessary. No side effects were observed. Panretinal photocoagulation (PRP) was performed as soon as feasible, five to 12 weeks after IVB treatment.
CONCLUSION: IVB leads to a rapid regression of iris and angle neovascularization and should be investigated more thoroughly as an adjunct in the management of NVG.

Gheith ME, Siam GA, de Barros DS, Garg SJ, Moster MR.
Role of intravitreal bevacizumab in neovascular glaucoma.
J Ocul Pharmacol Ther. 2007 Oct;23(5):487-91.
We report on the effect of intravitreal bevacizumab (IVB) for the treatment of neovascular glaucoma (NVG). A retrospective chart review of 6 consecutive cases of NVG was performed. The follow-up period was 3-19 months (average, 9.7 months). All patients received 1.25 mg (0.05 cc) of IVB followed by panretinal photocoagulation (PRP) approximately 1 week later. In all cases, there was a complete regression of iris and anterior chamber angle neovascularization. However, 2 eyes showed a recurrence of neovascularization; in 1 case, it recurred after 3 months, and in the second, after 5 months. These patients received another IVB injection followed by additional PRP, which resulted in the resolution of the recurrent neovascularization. Glaucoma was controlled with topical eye drops alone in patients who had iris and angle neovascularization without peripheral anterior synechiae (PAS). However, patients with PAS at the time of presentation needed subsequent glaucoma surgery. Our study suggests that IVB may be a valuable addition in the treatment of NVG by hastening the resolution of anterior segment neovascularization, improving the results of glaucoma surgeries, and appears to give long-term control when used in combination with PRP.

Vatavuk Z, Bencic G, Mandic Z.
Intravitreal bevacizumab for neovascular glaucoma following central retinal artery occlusion.
Eur J Ophthalmol. 2007 Mar-Apr;17(2):269-71.
PURPOSE: To report a case of neovascular glaucoma due to central retinal artery occlusion treated with a single intravitreal injection of bevacizumab. METHODS: A 68-year-old patient with a 10-week history of central retinal artery occlusion presented with neovascularization of the iris and the angle and intraocular pressure of 30 mm Hg. The patient received a single injection of 1.25 mg bevacizumab in 0.1 mL intravitreally. RESULTS: Iris and angle neovascularization regressed within 48 hours of the injection. Intraocular pressure dropped from 30 to 15 mm Hg, and there was marked improvement in patient comfort. Panretinal photocoagulation was applied 4 weeks after the injection.
CONCLUSIONS: Bevacizumab seems to be a useful adjunct to panretinal photocoagulation in the treatment of neovascular glaucoma.

Kahook MY, Schuman JS, Noecker RJ.
Intravitreal bevacizumab in a patient with neovascular glaucoma.
Ophthalmic Surg Lasers Imaging. 2006 Mar-Apr;37(2):144-6.
The utility of intravitreal bevacizumab injection in a patient with neovascular glaucoma following central retinal vein occlusion is explored. Bevacizumab (1 mg in 0.04 mL) was used after failed intraocular pressure (IOP) control with transscleral cyclophotocoagulation and panretinal photocoagulation. IOP improved within 2 days and the patient experienced marked improvement in comfort. Bevacizumab may be an effective medication for the treatment of neovascular glaucoma.

Yazdani S, Hendi K, Pakravan M.
Intravitreal bevacizumab (Avastin) injection for neovascular glaucoma.
J Glaucoma. 2007 Aug;16(5):437-9.
Neovascular glaucoma is a secondary glaucoma with grave prognosis which follows ischemic retinal disorders in the majority of cases. Mediators that induce new vessel formation such as the vascular endothelial growth factor-A seem to play a key role in the pathophysiology of this condition. Herein, we report 2 cases with neovascular glaucoma secondary to ischemic central retinal vein occlusion who received treatment with intravitreal bevacizumab (Avastin) a nonselective antibody against vascular endothelial growth factor-A. Both patients demonstrated dramatic short-term response in terms of intraocular pressure reduction and regression of neovascularization.

Grisanti S, Biester S, Peters S, Tatar O, Ziemssen F,
Bartz-Schmidt KU; Tuebingen Bevacizumab Study Group.

Intracameral bevacizumab for iris rubeosis.
Am J Ophthalmol. 2006 Jul;142(1):158-60.
PURPOSE: To determine whether intracameral bevacizumab decreases vascular leakage from iris rubeosis in patients with neovascular glaucoma. DESIGN: Interventional case series. METHODS: The study included six eyes of three patients with secondary neovascular glaucoma due to proliferative diabetic retinopathy (n = 2) or ischemic central retinal vein occlusion (n = 1). All patients received an intracameral injection of 1.0 mg bevacizumab. Morphologic changes and vascular leakage were investigated prospectively by iris fluorescein angiography. RESULTS: Decrease in leakage was detected as early as one day after injection. No inflammation was observed. No relapse was seen within the follow-up of four weeks.
CONCLUSION: Intraocular injection of bevacizumab may provide an additional strategy for the treatment of iris rubeosis in neovascular glaucoma.

Jiang Y, Liang X, Li X, Tao Y, Wang K.
Analysis of the clinical efficacy of intravitreal bevacizumab in the treatment of iris neovascularization caused by proliferative diabetic retinopathy
Acta Ophthalmol. 2008 Sep 18. [Epub ahead of print

Beutel J, Peters S, Lüke M, Aisenbrey S, Szurman P,
Spitzer MS, Yoeruek E; the Bevacizumab Study Group;
Grisanti S.
Bevacizumab as adjuvant for neovascular glaucoma.
Acta Ophthalmol. 2008 Sep 20

Intravitreal bevacizumab as an adjunct treatment for neovascular glaucoma.Hasanreisoglu M, Weinberger D, Mimouni K, Luski M, Bourla D, Kramer M, Robinson A, Axer-Siegel R.
Eur J Ophthalmol. 2009 Jul-Aug;19(4):607-12.
PMID: 19551676 [PubMed - in process]
Related ArticlesIntravitreal Bevacizumab in Refractory Neovascular Glaucoma

Aachal Kotecha; Alexander Spratt, MRCOphth; Lola Ogunbowale, MRCOphth; Roberto dell’Omo; Avinash Kulkarni, Catey Bunce; Wendy A. Franks,
Arch Ophthalmol. 2011;129(2):145-150. doi:10.1001/archophthalmol.2010.350

"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."

Chilov MN, Grigg JR, Playfair TJ.
Bevacizumab (Avastin) for the treatment of neovascular glaucoma.
Clin Experiment Ophthalmol. 2007 Jul;35(5):494-6.Herein three cases of angle closure secondary to neovascularization (elevated intraocular pressure in two of the cases) treated with the anti-vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) are reported. In all three cases there was rapid resolution of neovascularization and control of intraocular pressure. One patient with corneal anaesthesia from diabetes developed infectious keratitis, potentially as a consequence of inhibition of VEGF wound healing and neurotrophic functions. Avastin appears to have a promising role in the treatment of neovascular glaucoma but is not without potential local and systemic side-effects.

Canut M, Alvarez A, Nadal J, Abreu R, Abreu J, Pulido J
Anterior segment changes following intravitreal bevacizumab injection for treatment of neovascular glaucoma.

Clin Ophthalmol. 2011;5:715-9. Epub 2011 May 24.
"Intravitreal bevacizumab achieves complete regression of neovascularization in neovascular glaucoma secondary to proliferative diabetic retinopathy, and this regression is stable when associated with treatment of the underlying disease and should be investigated more thoroughly as an adjunct in the management of neovascular glaucoma."

Wolf A, von Jagow B, Ulbig M, Haritoglou C. Intracameral Injection of Bevacizumab for the Treatment of Neovascular Glaucoma. here
Ophthalmologica. 2011 May 5;226(2):51-56. [Epub ahead of print]

"The IOP-lowering effect of intracameral bevacizumab can be seen 1 week after the injection, but is limited to a period of approximately 3 weeks. However, the fast and effective response to intracameral bevacizumab injection opens a time window for additional treatments, which are often necessary."