INTRAVITREAL BEVACIZUMAB IN NEOVASCULAR GLAUCOMA - A CASE SERIES

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INTRAVITREAL BEVACIZUMAB IN NEOVASCULAR GLAUCOMA
- A CASE SERIES

• M. Kalev-Landoy, L. Zborowsky-Naveh, Z.
  Burgansky-Eliash
• Wolfson Medical Center, Holon, Israel

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Avastin (Bevacizumab)

• Approved by the FDA for the treatment of
  metastatic colorectal cancer.
• Anti VEGF (vascular endothelial growth factor)
  monoclonal antibody.
• Widespread off-label use in exudative AMD
• Effective with minimal side effects

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Avastin and NVG The Rationale

• NV (neovascularization) in the anterior segment
  2 to posterior segment ischemia anti-VEGF
  proven to cause regression in posterior segment
  NV.
• Background accumulating evidence in the
  literature about Avastin in the treatment of
  anterior segment NV. All with very good results.

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The Series

• 6 eyes of 6 patients with NVG.
• All 6 eyes with NV on the iris and in the angle
  with elevated IOP.
• All received intravitreal injection of 1.25mg
  Avastin.
• These cases demonstrates different clinical
  setting and treatment challenge.

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Case 1Avastin Trabeculectomy NV after full PRP

• 50 YO male
• 3 months s/p LE CRVO s/p PRP
• Presented with IOP61mm Hg
• NV of angle and iris.
• Trabeculectomy MMC intravitreal Avastin.
• Complete regression of NV within 3 days .
• At 3 months IOP 17, functioning bleb , no NV.

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Cases 2 3Avastin PRP

• 70 YO male NIDDM 81 YO male
• RE IOP-55 LE IOP-42
• NV, iris and angle 360.
• PRP Avastin
• At 3 days NV significant regression
• At 6 days complete regression
• Angle wide open, IOP 17 IOP 12
• At 6 months IOP 18. 1 mo IOP
  14

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Case 4Avastin NV after PRP

• 73 YO female, NIDDM.
• BE PDR s/p PRP
• Presented with LE IOP56mm
• NV LE , iris and angle.
• Avastin was injected augmentation of PRP
• At 3 days NV regressed dramatically, , at 5 days
  resolved.
• IOP 13 mmHg.

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Case 5Avastin only NV after full PRP

• 62 YO female, NIDDM.
• BE PDR s/p PRP (5 yr), POAG.
• LE s/p Diode laser cyclophotoablation.
• On routine follow-up, NV of angle was observed in
  LE with IOP 19 (previously stable on 15).
• Avastin was injected .
• At one week NV completely resolved ,
• IOP 14 mmHg.
• At 15 months stable.

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Case 6 Avastin only PRP not feasible

• 92 YO male.
• LE S/P CRAO.
• Presented with IOP 60.
• NV in angle and on the iris.
• PRP was technically impossible.
• Avastin was injected.
• At 3 days IOP was 15.
• At 6 days NV completely regressed.

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Summary

• All six of our patients responded to Avastin with
  quick regression of neovascularization and
  resolution of glaucoma within 3-7 days.

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Conclusions

• Avastin was effective as an adjuvant treatment to
  PRP for faster resolution.
• Avastin was effective instead of PRP when PRP
  could not be performed.
• Avastin is still an effective treatment even when
  NVG develops after full PRP.
• Controlled studies with larger series are needed
  to determine treatment guidelines.

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THANK YOU
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Case 3 after regression of NVI NVA
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