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Chiosi F., Chiosi A., Ippolito M., Lanzini G., Rampone A., Costagliola C.
Dipartimento di Oftalmologia Seconda Università di Napoli, Napoli
Aim. Neovascular glaucoma (NVG) represents one of the most severe forms of secondary glaucoma, caused by a number of ocular and systemic conditions, which share the common element of retinal ischemia/hypoxia that initiates the subsequent release of angiogenesis factors, with consequent development of new abnormal vessels through the ciliary body. The aim of this study was to examine the potential efficacy and safety of intravitreal injection of bevacizumab (IVB) (Avastin®) in the treatment of NVG in patients who had already undergone the standard retinal ablative procedure.
Methods. Clinical data of 4 eyes from 4 patients, including diagnosis, visual acuity, iris fluorescein angiography stage and intraocular pressure (IOP), were collected. Three injections of bevacizumab were scheduled for each recruited eye at 4-week intervals from the start. All investigations were repeated the day before the IVB (1.25 mg/0.05 mL) and at the 1-, 3-, 6-, 9- and 12-month follow-up.
Results. Regression of corneal edema together with significant pain reduction was achieved in all eyes already after the first IVB, without any noteworthy improvement of visual acuity. At the end of the scheduled protocol (three IVB), regression of iris neovascularization was documented in all patients, together with improvement of visual acuity. The mean IOP reduction from baseline was 9.5 mmHg.
Conclusion. Intravitreal bevacizumab, as adjunctive treatment to the standard retinal ablative procedure, seems promising for the management of proliferant diabetic retinophaty associated with neovascolar glaucoma limiting the VEGF production secondary to retinal ablative procedure.