Intravitreal bevacizumab in refractory neovascular glaucoma: A prospective, observational case series

Objective: To examine the efficacy of intravitreal bevacizumab for pain relief in eyes with refractory neovascular glaucoma. Methods: In this prospective case series, 52 eyes with neovascular glaucoma were administered intravitreal bevacizumab, 1.25 mg, and monitored for 6 months. The primary outcome measure was change in subjective pain score. Intraocular pressure and iris neovascularization were evaluated at each visit. Surgical intervention for control of intraocular pressure was performed according to clinical need. Results: Forty-two patients (44 eyes) completed the 6-month follow-up. Subjective pain score was reduced significantly 1 week after intravitreal bevacizumab injection and lasted throughout the follow-up period (median [interquartile range]: baseline, 3 [0-6]; week 1, 1 [0-3]; month 1, 0 [0-1]; month 3, 0 [0-1]; and month 6, 0 [0-0]; Kruskal-Wallis χ2 31.03; P<.001). A rapid, yet relatively transient, reduction in iris neovascularization was also noted (iris neovascularization grade at baseline, 4.0 [3-4]; week 1, 2.5 [1-4]; month 1,2.0 [1-4]; month 3, 3.0 [2-4]; and month 6, 3.0 [2-4], χ2 23.33; P<.001). Four eyes (8%) required more than 1 injection to facilitate further intraocular surgery. Conclusions: 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. ©2011 American Medical Association. All rights reserved.