Research supporting Avastin use in rubeotic glaucoma
- 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
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.
JO 3rd, Albert MA Jr, Mays A, Vail R.
Regression of neovascular iris vessels by intravitreal injection
Retina. 2006 Sep;26(7):839-41. No abstract available.
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
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
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
ME, Domig D, Wolf-Schnurrbursch U, Wolf S, Sarra GM.
Intravitreal bevacizumab (Avastin) in the treatment of neovascular
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.
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.
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.
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.
Bevacizumab seems to be a useful adjunct to panretinal photocoagulation
in the treatment of neovascular glaucoma.
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.
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.
S, Biester S, Peters S, Tatar O, Ziemssen F,
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
Analysis of the clinical efficacy of intravitreal bevacizumab in the
treatment of iris neovascularization caused by proliferative diabetic
Acta Ophthalmol. 2008
Sep 18. [Epub ahead of print
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.
2008 Sep 20
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]
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.
"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."
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
segment changes following intravitreal bevacizumab injection for
treatment of neovascular glaucoma.
Clin Ophthalmol. 2011;5:715-9. Epub 2011 May 24.
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."
Jagow B, Ulbig
C. Intracameral Injection of Bevacizumab for the Treatment
of Neovascular Glaucoma. here
May 5;226(2):51-56. [Epub ahead of print]
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."