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INTRAVITREAL BEVACIZUMAB IN NEOVASCULAR GLAUCOMA - A CASE SERIES

INTRAVITREAL BEVACIZUMAB IN NEOVASCULAR GLAUCOMA - A CASE SERIES. M. Kalev-Landoy, L. Zborowsky-Naveh, Z. Burgansky-Eliash Wolfson Medical Center, Holon, Israel. Avastin (Bevacizumab). Approved by the FDA for the treatment of metastatic colorectal cancer.

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INTRAVITREAL BEVACIZUMAB IN NEOVASCULAR GLAUCOMA - A CASE SERIES

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  1. INTRAVITREAL BEVACIZUMAB IN NEOVASCULAR GLAUCOMA - A CASE SERIES M. Kalev-Landoy, L. Zborowsky-Naveh, Z. Burgansky-Eliash Wolfson Medical Center, Holon, Israel

  2. Avastin (Bevacizumab) • Approved by the FDA for the treatment of metastatic colorectal cancer. • Anti VEGF (vascular endothelial growth factor) monoclonal antibody. • Widespread off-label use in exudative AMD • Effective with minimal side effects

  3. Avastin and NVG The Rationale • NV (neovascularization) in the anterior segment 2° to posterior segment ischemia – anti-VEGF proven to cause regression in posterior segment NV. • Background : accumulating evidence in the literature about Avastin in the treatment of anterior segment NV. All with very good results.

  4. The Series • 6 eyes of 6 patients with NVG. • All 6 eyes with NV on the iris and in the angle with elevated IOP. • All received intravitreal injection of 1.25mg Avastin. • These cases demonstrates different clinical setting and treatment challenge.

  5. Case 1Avastin & Trabeculectomy: NV after full PRP • 50 YO male • 3 months s/p LE CRVO s/p PRP • Presented with IOP=61mm Hg • NV of angle and iris. • Trabeculectomy +MMC + intravitreal Avastin. • Complete regression of NV within 3 days . • At 3 months IOP 17, functioning bleb , no NV.

  6. Cases 2 & 3Avastin & PRP • 70 YO male NIDDM 81 YO male • RE IOP-55 LE IOP-42 • NV, iris and angle 360°. • PRP + Avastin • At 3 days: NV significant regression • At 6 days:complete regression • Angle wide open, IOP 17 IOP 12 • At 6 months IOP 18. 1 mo IOP 14

  7. Case 4Avastin : NV after PRP • 73 YO female, NIDDM. • BE PDR s/p PRP • Presented with LE IOP=56mm • NV LE , iris and angle. • Avastin was injected + augmentation of PRP • At 3 days NV regressed dramatically, , at 5 days resolved. • IOP 13 mmHg.

  8. Case 5Avastin only: NV after full PRP • 62 YO female, NIDDM. • BE PDR s/p PRP (5 yr), POAG. • LE s/p Diode laser cyclophotoablation. • On routine follow-up, NV of angle was observed in LE with IOP 19 (previously stable on 15). • Avastin was injected . • At one week NV completely resolved , • IOP 14 mmHg. • At 15 months stable.

  9. Case 6Avastin only: PRP not feasible • 92 YO male. • LE S/P CRAO. • Presented with IOP = 60. • NV in angle and on the iris. • PRP was technically impossible. • Avastin was injected. • At 3 days IOP was 15. • At 6 days NV completely regressed.

  10. Summary • All six of our patients responded to Avastin with quick regression of neovascularization and resolution of glaucoma within 3-7 days.

  11. Conclusions • Avastin was effective as an adjuvant treatment to PRP for faster resolution. • Avastin was effective instead of PRP when PRP could not be performed. • Avastin is still an effective treatment even when NVG develops after full PRP. • Controlled studies with larger series are needed to determine treatment guidelines.

  12. THANK YOU

  13. Case 3 after regression of NVI & NVA

  14. References • Jonas JB, Spandau UH, Schlichtenbrede F. Intravitreal bevacizumab for filtering surgery. Ophthalmic Res.2007 Feb 2;39(2):121-122 • Iliev ME, Domig D, Wolf-Schnurrburch U, Wolf S, Sarra GM. Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma. Am J Ophthalmol. 2006 Dec;142(6):1054-6 • 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 • Davidorf FH, Mouser JG, Derick RJ. Rapid improvement of rubeosis iridis from a single bevacizumab (Avastin) injection. Retina. 2006 Mar; 26(3):354-6 • Oshima Y, Sakaguchi H, Gomi F, Tano Y. Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol. 2006 Jul;142(1):155-8 • Jayter Silva Paula et al. Short-term results of intravitreal bevacizumab (Avastin) on anterior segment neovascularization in neovascular glaucoma. Acta Ophthalmol Scand. 2006 Aug;84(4):556-7 • Salvatore Grisanti et al. Intracameral bevacizumab for iris rubeosis. Am J Ophthalmol. 2006 Jul;142(1):158-160 • Kahook MY, Schuman JS, Noecker RJ. Intravitreal bevacizumab in a patient with neovascular glaucoma. Ophthalmic Sur. Laser& Imaging. 2006 Mar/Apr;37(2):144-6

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