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Combined intravitreal bevacizumab/panretinal photocoagulation effective in early, sustained regression of neovascular glaucoma
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SAN FRANCISCO — Combining bevacizumab injections and panretinal photocoagulation for the treatment of neovascular glaucoma successfully produced early regression and lesser recurrence of the disease, Arup Chakrabarti, MS, said at the American Society of Cataract and Refractive Surgery meeting here.
"Effect of intervention in causing regression of neovascular glaucoma and reducing the time to regression was most significant in the group which received combined (panretinal photocoagulation) and (intravitreal bevacizumab) treatment," he said.
Dr. Chakrabarti presented the results of a prospective, interventional study that he conducted with colleagues. The study examined 38 eyes with neovascular glaucoma, divided into three treatment groups: a panretinal photocoagulation group, an intravitreal Avastin (bevacizumab) group and a combined treatment group. Follow-up was 12 months.
The study found that the time to neovascular glaucoma regression was statistically significantly least in the combined group. In panretinal photocoagulation alone cases, recurrence occurred in 53.3%, while in the combined group, recurrence was 20%, Dr. Chakrabarti said.
His presentation received the best paper of the session award.
The results from this prospective clinical study are indeed helpful in the clinical management of this visually disabling refractory glaucoma. They confirm clinically the anecdotal experiences of many clinicians that intravitreal bevacizumab injections do supplement the beneficial effects of panretinal photocoagulation in neovascular glaucoma. The important take-home point is that combination therapy (bevacizumab and panretinal photocoagulation) was found to be superior to either treatment alone in producing early regression and reduced recurrence of disease. It is hoped that the authors will continue to follow the long-term visual outcomes of these treated patients.
– James C. Tsai, MD
Yale University School of Medicine