Clinical and electrophysiologic outcome in patients with neovascular glaucoma treated with and without bevacizumab

Department of Ophthalmology, Lund University, Lund, Sweden.
European journal of ophthalmology (Impact Factor: 1.07). 11/2011; 22(4):563-74. DOI: 10.5301/ejo.5000089
Source: PubMed


To investigate the clinical and electrophysiologic effect of a single intravitreal injection of bevacizumab for neovascular glaucoma (NVG) after ischemic central retinal vein occlusion (iCRVO).
Nineteen eyes from 19 patients with NVG secondary to iCRVO were randomly allocated to either an intravitreal bevacizumab injection and panretinal photocoagulation (PRP) (10 eyes) or PRP alone (9 eyes). The primary outcome measure was the change in the total retinal function 6 months after treatment, demonstrated by full-field electroretinography (ERG). Secondary outcomes included visual acuity, intraocular pressure (IOP), glaucoma medication, additional IOP-lowering treatment, and the presence of ocular neovascularization before treatment, and 1 week, 2 months, and 6 months after treatment.
The regression of ocular neovascularization in the bevacizumab/PRP group was confirmed 1 week after injection. Patients in both study groups had very poor visual acuity at baseline. This remained unchanged. There was no significant difference in the mean IOP between the groups at any point in time. The a-wave amplitudes of combined rod-cone response were significantly decreased after 6 months in the bevacizumab/PRP group (p=0.028), compared with the baseline values. The a- and b-wave amplitudes of combined rod-cone response and the b-wave amplitudes of the 30-Hz flicker response were also markedly reduced compared with the PRP group (-60%, -43%, -47% vs +23%, -36%, -16%, respectively).
This study suggests that intravitreal injection of bevacizumab is valuable in the treatment of NVG by hastening the resolution of neovascularization, while the full-field ERG results indicate that bevacizumab may reduce the photoreceptor function in NVG patients.

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    • "At a minimum, our findings suggest that risks to patients with glaucoma may need to be more systematically and rigorously assessed. Based on full-field electroretinographic results, it was recently reported that VEGF neutralization with bevacizumab regressed neovascularization and also reduced photoreceptor function in patients with neovascular glaucoma.49 Furthermore, a study observing 49 patients with age-related macular degeneration found that, in eyes treated with ranibizumab, nerve fiber layer thickness was significantly reduced after 1 year of treatment, whereas untreated control eyes displayed no change.50 "
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    ABSTRACT: The use of antivascular endothelial growth factors such as bevacizumab and ranibizumab has brought about a revolution in management protocols of various ophthalmic disorders. A lot has been written about these agents, still lacunae exist in our understanding due to paucity of randomized control trials with large number of patients. This brief review attempts to throw light on the clinical applications of these molecules for glaucoma.
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