Advances in Therapy

, Volume 25, Issue 5, pp 438–443

Surgical outcome of intravitreal bevacizumab and filtration surgery in neovascular glaucoma

  • Naris Kitnarong
  • Panida Chindasub
  • Ankana Metheetrairut
Original Research

DOI: 10.1007/s12325-008-0047-5

Cite this article as:
Kitnarong, N., Chindasub, P. & Metheetrairut, A. Adv Therapy (2008) 25: 438. doi:10.1007/s12325-008-0047-5

Abstract

Introduction

The purpose of this study was to evaluate the surgical outcome of a trabeculectomy with mitomycin C (MMC) in neovascular glaucoma after an adjunctive treatment with intravitreal bevacizumab (Avastin®; Genentech Inc, San Francisco, CA, USA) injection (IVB).

Methods

Six patients with NVG presented at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. After adequate panretinal photocoagulation (PRP) and maximal antiglaucoma medication therapy, these patients received IVB (1.25 mg in 0.05 ml) due to persistent neovascularisation of the iris (NVI). A fornix-based conjunctival flap trabeculectomy with MMC was performed within 4 weeks following administration of IVB.

Results

Three patients with proliferative diabetic retinopathy (PDR) and three patients with central retinal vein occlusion (CRVO) were enrolled in the study (mean age, 57 years). Absolute regression of NVI was observed within 1 week after IVB in four patients. In two patients NVI was reduced but still persisted. Mean intraocular pressure (IOP) decreased from 39.8 mmHg pre-operatively to 7.5 mmHg on the first postoperative day. No intra-operative complications were noted. Two patients had postoperative hyphema, which resolved spontaneously within 1 week. During the mean follow up of 24.7 weeks, five patients had controlled IOP (range, 2–16 mmHg) without antiglaucoma medication. Two patients with PDR had improved visual acuity whereas two patients with CRVO lost pre-operative light perception. Recurrent NVI was subsequently detected in one patient who had uncontrolled IOP. This patient underwent transscleral diode laser cyclophotocoagulation and additional PRP. All patients were symptom-free at last visit.

Conclusion

IVB is an effective modality to reduce intra-operative complications during trabeculectomy for neovascular glaucoma. The short-term outcomes following trabeculectomy with MMC are favourable.

Keywords

angiogenesis inhibitorsdiabetic retinopathyglaucomaintraocular pressureiris/surgerylaser coagulationretinal vein occlusionvascular endothelial growth factor A

Copyright information

© Springer Healthcare Communications 2008

Authors and Affiliations

  • Naris Kitnarong
    • 1
  • Panida Chindasub
    • 1
  • Ankana Metheetrairut
    • 1
  1. 1.Department of Ophthalmology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand