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Surgeon: Combination of bevacizumab and PRP rapidly lowers IOP, prevents further surgery
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PHILADELPHIA — Combination bevacizumab and panretinal photocoagulation proved more effective than panretinal photocoagulation alone in treating patients who have neovascular glaucoma, according to a surgeon speaking here at the Wills Eye Institute 60th Annual Alumni Conference.
"[Neovascular glaucoma] is difficult to manage and often requires surgical intervention," Justis P. Ehlers, MD, said. "Currently, the gold standard is to use extensive panretinal photocoagulation (PRP) and initial medical management of intraocular pressure. It has many treatment challenges. PRP takes several weeks to take full effect. During this time, progressive angle closure may occur."
Dr. Ehlers discussed the results of a retrospective case study that included 23 patients. Of these, 11 patients received combined treatment with Avastin (bevacizumab, Genentech) and PRP and 12 received PRP only.
Researchers hypothesized that combining PRP and anti-VEGF medication on the same day may help stabilize disease progression, speed control of anterior segment neovascularization and eliminate the need for further surgery, Dr. Ehlers said.
At 4 months to 5 months follow-up, investigators found that the combined treatment group had a mean IOP reduction of about 20 mm Hg, while the PRP-only group had a mean IOP decrease of about 7 mm Hg, he said.
Also, the combined treatment group had a more rapid regression of neovascularization compared with the PRP-only group, he noted.
No patients required surgical intervention, Dr. Ehlers said.
Both groups showed similar visual outcomes, although there was a trend toward a lower incidence of absolute glaucoma and a lower final IOP in patients treated with the combination therapy, he said.