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Combined therapy regimen reduces vessel formation, controls IOP in neovascular glaucoma

Eur J Ophthalmol. 2009; 19:1029-1034.

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Intravitreal anti-VEGF therapy reduces neovascularization and aids IOP reduction in patients with open-angle neovascular glaucoma, and the effect can be further enhanced with panretinal photocoagulation, according to a study.

Nine patients received a 1.25-mg dose of intravitreal Avastin (bevacizumab, Genentech) followed by panretinal photocoagulation 2 to 4 weeks later. The bevacizumab dose reduced mean IOP from 35.1 mm Hg at baseline, when patients were being treated with topical and systemic anti-glaucoma medications, to 22.8 mm Hg prior to laser therapy. After laser therapy, mean IOP was further reduced to 13 mm Hg.

At the time of referral, the mean iris neovascularization grade was 3.6 on a scale of 0 to 4, but was reduced to a mean of 1.6 after bevacizumab therapy and a mean of 0.6 after completion of the combined therapy regimen.

Mean neovascularization of angle and the need for IOP controlling medications were also reduced, and no recurrence of iris neovascularization was noted. Final visual acuity improved in four eyes and was maintained in five eyes.