J Korean Ophthalmol Soc.  2015 Jun;56(6):917-924. 10.3341/jkos.2015.56.6.917.

The Effect of Intravitreal Bevacizumab Injection before Trabeculectomy in Patients with Neovascular Glaucoma

• Lee YH
• Kim R
• Chang SD

• KMID: 2339158
• DOI: http://doi.org/10.3341/jkos.2015.56.6.917

Abstract

PURPOSE
To evaluate the efficacy of preoperative intravitreal bevacizumab injection (IVBI) and prognostic factors of surgical success in neovascular glaucoma patients, who underwent trabeculectomy.
METHODS
A total of 58 patients (58 eyes) diagnosed with neovascular glaucoma who underwent trabeculectomy between 2003 and 2013 were enrolled in this retrospective study. Trabeculectomy with mitomycin C was performed between 2003 and 2006 and additional preoperative IVBI with the above mentioned technique was performed between 2007 and 2013. To evaluate the efficacy of preoperative IVBI, the patients were divided into the preoperative IVBI group and control group. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured from preoperative to postoperative 12 months. To evaluate the prognostic factors related to surgical success, the following was investigated: age, lens status, preoperative IVBI, time interval between preoperative IVBI and trabeculectomy, previous vitrectomy and, postoperative complications.
RESULTS
Trabeculectomy with mitomycin C only was performed in 26 eyes and additional preoperative IVBI was performed in 32 eyes. Surgical success was 81.3% in the IVBI group and 57.7% in the control group at postoperative 6 months (p = 0.012), and 78.1% in the IVBI group and 50.0% in the control group at postoperative 12 months (p = 0.021). Statistically significant IOP reduction effect was observed in the IVBI group (p = 0.048), and reduced anti-glaucoma eye drop usage was observed in the IVBI group (0.4) compared with 0.8 in the control group (p = 0.040). Postoperative hyphema (hazard ratio [HR] = 2.872, p = 0.044) and preoperative IVBI (HR = 0.280, p = 0.030) were considered risk factors for surgical failure in univariate analysis, however, only preoperative IVBI was statistically significant in multivariate analysis (p = 0.046).
CONCLUSIONS
In neovascular glaucoma patients, preoperative IVBI before trabeculectomy is a good prognostic factor of surgical success and shows benefit in lowering the IOP and reducing anti-glaucoma eye drop usage at postoperative 1 year.

Keyword

Bevacizumab; Hyphema; Neovascular glaucoma; Trabeculectomy

MeSH Terms

Glaucoma, Neovascular*
Humans
Hyphema
Intraocular Pressure
Mitomycin
Multivariate Analysis
Postoperative Complications
Retrospective Studies
Risk Factors
Trabeculectomy*
Visual Acuity
Vitrectomy
Bevacizumab
Mitomycin

Figure

• 

  Figure 1. Cumulative probability of the surgical success of the preoperative intravitreal bevacizumab injection (IVBI) group and the control group after trabeculectomy for neovascular glaucoma by Kaplan-Meier Survival Analysis.

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  Figure 2. Mean best corrected visual acuity (BCVA, log MAR) changes in the preoperative intravitreal bevacizumab injection (IVBI) group and the control group after trabeculectomy for neovascular glaucoma. PreOP = preoperation. *Statistically significant changes compared to preoperative BCVA in IVBI group; †Statistically significant changes compared to preoperative BCVA in control group.

• 

  Figure 3. Mean intraocular pressure (IOP) changes in the pre-operative intravitreal bevacizumab injection (IVBI) group and the control group after trabeculectomy for neovascular glaucoma. PreOP = preoperation. *Statistically significant changes compared to preoperative IOP in IVBI group. †Statistically significant changes compared to preoperative IOP in control group.

Reference

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