Korean J Ophthalmol.  2009 Sep;23(3):215-218. 10.3341/kjo.2009.23.3.215.

Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion

• Sagong M
• Kim J
• Chang W

• KMID: 1115757
• DOI: http://doi.org/10.3341/kjo.2009.23.3.215

Abstract

We report three cases of neovascular glaucoma secondary to central retinal artery occlusion (CRAO) which were effectively managed with intravitreal bevacizumab (IVB) followed by panretinal photocoagulation (PRP). Neovascular glaucoma without peripheral anterior synechiae developed between one and five weeks following CRAO onset. All patients received 0.75 mg (0.03 ml) IVB. In all patients, complete regression of the iris and anterior chamber angle neovascularization was confirmed within one week. PRP was applied two weeks after the injection. The follow-up period was four to seven months (average, five months). Intraocular pressure was controlled in all patients using topical antiglaucoma medications alone. However, one patient experienced a recurrence of neovascularization three months after the initial combination treatment. This patient received another IVB injection and additional PRP, and the recurrent neovascularization resolved. There were no local or systemic adverse events in any patients. Therefore, intravitreal bevacizumab may be an effective adjunct in the treatment of neovascular glaucoma associated with CRAO.

Keyword

Central retinal artery occlusion; Intravitreal bevacizumab; Neovascular glaucoma; Panretinal photocoagulation

MeSH Terms

Aged
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Female
Glaucoma, Neovascular/*drug therapy/*etiology
Humans
Injections
Male
Middle Aged
Recurrence
Retinal Artery Occlusion/*complications
Retreatment
Treatment Outcome
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Vitreous Body

Reference

1. Gartner S, Henkind P. Neovascularization of the iris (rubeosis iridis). Surv Ophthalmol. 1978. 22:291–312.

2. Duker JS, Brown GC. Neovascularization of the optic nerve associated with obstruction of the central retinal artery. Ophthalmology. 1989. 96:87–91.

3. Hayreh SS, Podhajsky P. Ocular neovascularization with retinal vascular occlusion. II. Occurrence in central and branch retinal artery occlusion. Arch Ophthalmol. 1982. 100:1585–1596.

4. Sivak-Callcott JA, O'Day DM, Gass JD, Tsai JC. Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology. 2001. 108:1767–1776.

5. Ehlers JP, Spirn MJ, Lam A, et al. Comparison intravitreal bevacizumab/panretinal photocoagulation versus panretinal photocoagulation alone in the treatment of neovascular glaucoma. Retina. 2008. 28:696–702.

6. Tripathi RC, Li J, Tripathi BJ, et al. Increased level of vascular endothelial growth factor in aqueous humor of patients with neovascular glaucoma. Ophthalmology. 1998. 105:232–237.

7. Beer PM, Wong SJ, Hammad AM, et al. Vitreous levels of unbound bevacizumab and unbound vascular endothelial growth factor in two patients. Retina. 2006. 26:871–876.

8. Bakri SJ, Snyder MR, Reid JM, et al. Pharmacokinetics of intravitreal bevacizumab (Avastin). Ophthalmology. 2007. 114:855–859.

9. Iliev ME, Domig D, Wolf-Schnurrbursch U, et al. Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma. Am J Ophthalmol. 2006. 142:1054–1056.

10. Chilov MN, Grigg JR, Playfair TJ. Bevacizumab (Avastin) for the treatment of neovascular glaucoma. Clin Experiment Ophthalmol. 2007. 35:494–496.

11. Maeng H, Kim J, Kee C. Intravitreal bevacizumab (Avastin) injection for the treatment of early-stage neovascular glaucoma. J Korean Ophthalmol Soc. 2008. 49:696–700.

12. Gheith ME, Siam GA, Barros MD, et al. Role of intravitreal bevacizumab in neovascular glaucoma. J Ocul Pharmacol Ther. 2007. 23:487–491.

13. Brown GC, Magargal LE, Simeone FA, et al. Arterial obstruction and ocular neovascularization. Ophthalmology. 1982. 89:139–146.

14. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994. 331:1480–1487.

15. Duker JS, Brown GC. The efficacy of panretinal photocoagulation for neovascularization of the iris after central retinal artery obstruction. Ophthalmology. 1989. 96:92–95.

16. Laatikainen L. A prospective follow-up study of panretinal photocoagulation in preventing neovascular glaucoma following ischaemic central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 1983. 220:236–239.

17. Ferrara N. Role of vascular endothelial growth factor in physiologic and pathologic angiogenesis: therapeutic implications. Semin Oncol. 2002. 29:suppl. 10–14.

18. Ferrara N, Hillan KJ, Gerber HP, Novotny W. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 2004. 3:391–400.

19. Vatavuk Z, Mandic BZ. Intravitreal bevacizumab for neovascular glaucoma following central retinal artery occlusion. Eur J Ophthalmol. 2007. 17:269–271.

20. Lynch SS, Cheng CM. Bevacizumab for neovascular ocular diseases. Ann Pharmacother. 2007. 41:614–625.

21. Fung AE, Rosenfeld PJ, Reichel E. The international intravitreal bevacizumab safety survey: using the internet to assess drug safety worldwide. Br J Ophthalmol. 2006. 90:1344–1349.

22. Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006. 113:1695–1705.

23. Wakabayashi T, Oshima Y, Sakguchi H, et al. Intravitreal bevacizumab to treat iris neovascularization and neovascular glaucoma secondary to ischemic retinal disease in 41 consecutive cases. Ophthalmology. 2008. 115:1571–1580.