Anti-VEGF, trabeculectomy with mitomycin C could help treat neovascular glaucoma

J Glaucoma. 2010;19(9):622-626.

Issue: February 10, 2011

More than 80% of patients with neovascular glaucoma who were treated with intravitreal bevacizumab and panretinal photocoagulation achieved complete regression of iris neovascularization, and mean IOP was significantly reduced after trabeculectomy with mitomycin C, according to a study.

Of the 17 eyes of 15 patients included in the study, 14 had complete regression of iris neovascularization after receiving intravitreal Avastin (bevacizumab, Genentech) combined with panretinal photocoagulation.

After a subsequent trabeculectomy with intraoperative mitomycin C, researchers observed a statistically significant reduction in mean IOP (P < .05).

At week 1, mean IOP was reduced from 42.9 mm Hg preoperatively to 15.1 mm Hg. After 1 month and 6 months, mean IOP was reduced to 16.3 mm Hg and 19.7 mm Hg, respectively, according to the study.

In addition, the mean number of anti-glaucoma medications was reduced from 2.8 before surgery to 0.8 after surgery.

Neovascular glaucoma was caused by diabetic retinopathy in 10 eyes, central retinal vein occlusion in five eyes and branch retinal vein occlusion in two eyes.

Complications in order of prevalence included hyphema, postoperative hypotony, shallow anterior chamber, choroidal detachment, conjunctival dehiscence and epithelial corneal erosion related to mitomycin C application.

Alkawas and colleagues report a case series of neovascular glaucoma patients treated initially with panretinal photocoagulation and intravitreal bevacizumab followed by trabeculectomy with mitomycin C. Their findings indicate that combination therapy for neovascular glaucoma may be appropriate and may lead to successful lowering of IOP after 6 months of follow-up. As more information is published regarding the use of intravitreal bevacizumab for the treatment of neovascular glaucoma, clinicians will be better able to adapt anti-VEGF therapy to current clinical practices, with the ultimate hope of improved patient comfort and enhanced postoperative outcomes. Prospective, randomized clinical trials will be needed before truly understanding the implications of the early findings reported in this study, as well as many other similar studies published in the past regarding the treatment of neovascular glaucoma.

– Malik Kahook, MD
Denver, Colo.
Disclosure: Dr. Kahook has received research support from Genentech, Allergan, Alcon, Merck and Actelion. He is consultant to Alcon, Allergan, Merck and Genentech and a founding member of Shape Ophthalmics LLC.