Neovascular glaucoma (NVG) often occurs secondary to ocular ischemic diseases and is refractory glaucoma. Intravitreal injection of bevacizumab offers a new approach to the rapid regression of anterior segment neovascularization and therefore is used as an adjunct therapy of NVG. However, the efficacy of intravitreal injection of bevacizumab combined with anti-glaucoma surgery NVG is still explorating.

This clinical study was to assess the efficacy and safety of intraocular injection of bevacizumab combined with trabeculectomy (Trab) or cyclophotocoagulation (CPC) for NVG and explore a optimal treating flowchart.

This study was approved by Ethic Committee of Peking University Third Hospital, and written informed consent was obtained prior to any medical procedure. This was a nonrandomized case control study. Twenty-three eyes of 23 patients with NVG were collected from January 2012 to March 2013 in Peking University Third Hospital. The patients were grouped to the Trab group (9 eyes) and the CPC group (14 eyes) with the matched demography between the two groups. Bevacizumab at the dose of 1.25 mg (50 μl) was initially injected via the anterior chamber to vitreous, and then the corresponding surgery was performed on the NVG eyes in different groups. The visual acuity, intraocular pressure (IOP) and treatment-related indexes were examined 1 week and 3 months after operation. The intraoperative and postoperative complications were evaluated. A flowchart of combination procedure for NVG was established.

No significant difference was found in the demography between the two groups (all at P>0.05). The IOPs were (43.4±6.2), (15.6±3.0) and (19.7±3.2) mmHg before operation and 1 week, 3 months after operation in the Trab group, and those in the CPC group were (42.8±4.9), (25.4±7.5) and (23.3±6.6) mmHg, with significant differences between different groups and time points (F_group=28.817, P<0.001; F_time=158.418, P<0.001; F_interaction=7.260, P=0.002), and it showed significant lowing of IOP in 1 week and 3 months after operation in comparison with before operation (both at P<0.001). The IOP was significantly higher in the CPC group than that in the Trab group at 1 week after operation (P<0.01), but no significant difference in IOP at 3 months between the two groups (P=0.095). At the third month after surgery, visual acuity declined in 3 eyes in the Trab group and 9 eyes in the CPC group, with a significant difference between them (P=0.042). The interval time from intraocular injection of bevacizumab to surgery and from surgery to sequential treatment was longer in the CPC group than that in the Trab group (P=0.002, 0.003). There was no complication in both groups.

Intravitreal injection of bevacizumab can not reduce IOP in the NGV with angle closure but lessen complication associated with anti-glaucoma surgery. The combination of bevacizumab and Trab provides more rapid control of IOP than the combination of bevacizumab and CPC, which is important for maintaining visual function in late stage of NVG eye.

Angiogenesis inhibitor/therapeutic use; Antibodies, monoclonal, humanized/therapeutic use; Combined modality therapy; Glaucoma, neovascular/therapy; Intraocular pressure; Intravitreal injection; Trabeculectomy; Cyclophotocoagulation; Vascular endothelial growth factor/antagonist & inhibitor