The outcome of Concurrent Diode Laser Cyclophotocoagulation and Bevacizumab for Treatment of Neovascular Glaucoma

Abstract

Background: Neovascular glaucoma is a significant cause of blindness over the globe. Effective treatment with introduction of new medications opens a window of hope for those patients. However, and due to delayed presentation, available treatment options are not sufficient. The Aim of The Work: The current study aimed to investigate the effectiveness of combined use of diode laser cyclophotocoagulation and intravitreal injection of bevacizumab for treatment of Neovascular Glaucoma.Patients and Methods: Twenty seven patients (32 eyes) were included. All were clinically evaluated by a clinical and ophthalmic examination. Visual acuity was tested by the Snellen’s chart. Then, a slit-lamp examination was performed and Goldman applanation tonometry was used for intraocular pressure (IOP) measurement followed by fundus examination. The diode laser cyclophotocoagulation (CPC) and intravitreal injection of bevacizumab was performed and outcome was documented. The primary outcome included control of IOP (30% or more reduction of basal IOP), pain relief, and regression of neovascularization of the anterior segment. Patients were followed up in a scheduled visits at 1, 3 and 6 months, where they were clinically assessed in a systematic manner.Results: Patient’s age ranged between 39 and 70 years and males represented 55.6%. The diagnosis of NVG was mainly due to proliferative diabetic retinopathy (56.6%). Pain score showed progressive significant sustained reduction after treatment and only two patients reported moderate pain at the end of follow up. Visual acuity also significantly improved after intervention among 40.6%, remained stationary among 46.9% and deteriorated among 4 patients. The reduction of IOP by more than 30% of the basal values was achieved among 87.5%, while iris revascularization was reported among 12.5%. Conclusion: The combination of CPC and bevacizumab treatment in NVG is a promising approach to achieve a sufficient regression of angle neovascularization, consistent IOP reduction and symptomatic pain relief.

Keywords

• glaucoma
• vascular endothelial growth factor
• cyclophotocoagulation
• bevacizumab