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. • Anti VEGF (vascular endothelial growth factor) monoclonal antibody. • Widespread off-label use in exudative AMD • Effective with minimal side effects
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.
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.
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.
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
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.
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.
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.
Summary • All six of our patients responded to Avastin with quick regression of neovascularization and resolution of glaucoma within 3-7 days.
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.
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