Intraocular Pressure Following Combined Routes of Bevacizumab-augmented Trabeculectomy for Refractory Neovascular Glaucoma

ABSTRACT

Purpose: To evaluate the intraocular pressure (IOP) control following combined routes of adjuvant bevacizumab with trabeculectomy in refractory neovascular glaucoma. Methods: From June 2011 to December 2011, 5 consecutive cases of neovascular glaucoma with persistent raised IOP on maximal medical treatment underwent adjuvant bevacizumab by combined routes (subconjunctival (SC) and/or intracameral (IC), intravitreal (IV) injections) before pan-retinal photocoagulation (PRP). Needs for repeat procedures or medications for IOP control over the postoperative period were assessed. Results: The mean IOP (1 SC, 1 IC + IV, 3 SC + IC routes) reduced from 40 ± 5.5 mm Hg to 17 ± 3.7 mm Hg at a mean final follow-up of 4 ± 3.7months (range 1–9 months), respectively (p < 0.001 for each). All eyes had transient IOP spikes 1–3 months after surgery, which normalized spontaneously after PRP, while one eye required topical medications for IOP control. Conclusions: Combined routes of adjuvant bevacizumab augmented trabeculectomy may help in better IOP control (IC + IV > IC + SC > SC) in refractory neovascular glaucoma but require additional procedures for sustained effect.

• Angiogenesis
• bevacizumab
• neovascular glaucoma
• trabeculectomy
• VEGF