Surgical Outcomes of Intravitreal Bevacizumab and Guarded Filtration Surgery in Neovascular Glaucoma

Purpose: To assess the efficacy of preoperative intravitreal bevacizumab with guarded filtration surgery and mitomycin C in neovascular glaucoma. Materials and Methods: In this prospective, noncomparative interventional case series, neovascular glaucoma patients who had not responded to or could not receive panretinal photocoagulation were recruited. Patients received 1.25 mg of intravitreal bevacizumab. If needed, the bevacizumab injection was repeated. Patients who could not achieve an intraocular pressure <= 21 mm Hg despite medications underwent trabeculectomy with mitomycin C. Success defined as complete if intraocular pressure was 6 to 21mm Hg without medication, and qualified if intraocular pressure was within above range with glaucoma medication. Failure was defined as intraocular pressure < 6 or > 21 mm Hg despite medications or reoperation. Results: Thirty eyes were treated. All patients demonstrated complete regression of iris neovascularization with 1 or 2 intravitreal bevacizumab injections. The mean intraocular pressure was 43.1 +/- 9.3 and 38.9 +/- 12.5 before and 2 weeks after bevacizumab injection, respectively (P < 0.003). The intraocular pressure in 3 cases was controlled after receiving bevacizumab. In 23 cases that underwent filtering surgery and completed at least 6 months of follow-up, the mean preoperative and last visit intraocular pressure was 43.3 +/- 10.0 mm Hg and 20.6 +/- 5.4 mm Hg, respectively (P < 0.001). The qualified success rate was 61% at final visit. Neither the significant intraoperative nor postoperative complications were noted. Conclusions: Preoperative intravitreal bevacizumab combined with guarded filtration surgery with mitomycin C is a safe and effective method of controlling intraocular pressure in neovascular glaucoma.