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

Introduction. - 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. Patients and 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. Discussion. - 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. Conclusion. - Intravitreal bevacizumab was effective in reversing iris neovascularization in association with panretinal photocoagulation and cyclophotocoagulation. (C) 2009 Elsevier Masson SAS. All rights reserved.