Clinical Factors Related to Recurrence of Anterior Segment Neovascularization After Treatment Including Intravitreal Bevacizumab

PURPOSE: To investigate the impact of clinical factors on the recurrence of anterior segment neovascularization after intravitreal bevacizumab injection. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Charts of 54 eyes of 54 consecutive patients who received intravitreal bevacizumab injections (1.25 mg) for the treatment of anterior segment neovascularization were reviewed. The mean follow-up period :I: standard deviation was 16 +/- 8 months (range, 4 to 31 months). For eyes with incomplete panretinal photocoagulation, additional retinal ablation was performed within 1 month after bevacizumab injection. Differences in clinical factors were compared between eyes with and without recurrence. Baseline clinical factors were age, gender, predisposing diagnosis, status and clinical stages of anterior segment neovascularization, fundus neovascularization, visual acuity, baseline intraocular pressure, previous retinal ablation, previous intraocular surgeries, lens status, history of glaucoma, hemoglobin A1c level, hypertension, and creatinine level. Factors after intravitreal bevacizumab administration were additional retinal ablation, intraocular surgeries, mean intraocular pressure until recurrence, and visual acuity. Univariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the contribution of these factors to recurrence. Kaplan-Meier survival analysis with the log-rank test was performed with recurrence as the end point. RESULTS: Recurrence occurred in 26 (48%) eyes a mean +/- standard deviation of 4.7 +/- 3.0 months (range, 2 to 11 months) after bevacizumab injection. Multivariate analysis identified trabeculectomy after bevacizumab injection as the primary inhibitory factor for recurrence (hazard ratio, 0.23; 95% confidence interval, 0.094 to 0.55; P = .001). Kaplan-Meier survival analysis showed that trabeculectomy after bevacizumab injection provided a significantly better survival rate (P < .001). CONCLUSIONS: Recurrence of anterior segment neovascularization after intravitreal bevacizumab injection occurs despite intensive retinal ablation: trabeculectomy may suppress recurrence. (Am J Ophthalmol 2010; 149:964-972. (C) 2010 by Elsevier Inc. All rights reserved.)