Intravitreal bevacizumab combined with panretinal photocoagulation in the treatment of open angle neovascular glaucoma.

PURPOSE. To evaluate the clinical efficacy of intravitreal bevacizumab (IVB) combined with panretinal photocoagulation in patients with open angle neovascular glaucoma (NVG). METHODS. Nine patients (9 eyes) with NVG participated in this study. Patients received IVB (1.25 mg) as the initial treatment for NVG and were followed up for at least 4 months. IVB was offered as the first treatment of choice to patients with NVG. Panretinal photocoagulation was performed as soon as feasible after the second week and completed in all patients the fourth week after IVB. The main outcome measures are resolution of INV, inhibition of peripheral anterior synechia (PAS), and controllability of intraocular pressure (IOP). RESULTS. The mean follow-up period was 5.6 +/- 1.4 months (range, 4-9 months). The mean IOP before treatment was 35.1 +/- 9.7 mmHg (range, 24-56) under medication before IVB treatment. After IVB and after combined treatment, the mean IOP was reduced to 22.8 +/- 8.1 mmHg (range, 9-33) and 13.0 +/- 4.0 mmHg (range, 7-20), respectively. The mean referral INV was 3.6 +/- 0.4 grade (range, 3-4) and reduced to 1.6 +/- 0.4 (range 1-2) grade after IVB and 0.6 +/- 0.8 (range 0-2) grade after combined therapy. By IVB, combined panretinal photocoagulation recurrence of INV was not observed. CONCLUSIONS. In NVG, IVB treatment can reduce iris and angle neovascularization and inhibits further PAS formation temporarily. Panretinal photocoagulation inhibits neovascularization constantly. Therefore, management of open angle NVG is more feasible with bevacizumab combined with panretinal photocoagulation. (Eur J Ophthalmol 2009; 1028-33)