Intracameral bevacizumab resolves neovascularization

February 1, 2007

Las Vegas-Intracameral injection of the anti-VEGF antibody bevacizumab (Avastin, Genentech) dramatically resolves iris neovascularization and reverses neovascular glaucoma, according to the findings of a retrospective study presented here at the annual meeting of the American Academy of Ophthalmology.

Kakarla V. Chalam, MD, PhD, professor of ophthalmology, University of Florida, Jacksonville, reported experience accumulated over a 10-month period treating 16 eyes of 15 patients with intracameral bevacizumab 1.25 mg/0.05 ml. Two eyes in the series received a repeat injection at 1 month for recurrent iris neovascularization. Nine eyes had neovascular glaucoma.

No complications or adverse events were associated with the treatment. Iris neovascularization regressed in 15 (94%) eyes, and in eight (89%) of the eyes with neovascular glaucoma, the glaucoma could be controlled with medical therapy. Prior treatment with bevacizumab appeared to enable the shunt surgery that was necessary in the remaining eye, Dr. Chalam said.

Patients were eligible to receive intracameral bevacizumab if they had active iris neovascularization unresponsive to conventional treatment. Individuals with uncontrolled hypertension or a history of myocardial infarction or cerebral vascular incident were excluded.

Weekly follow-up

The injection was delivered through the limbus after aspirating 0.1 ml of aqueous. Patients were seen on the first day after surgery and then at weekly intervals. Follow-up assessments included measurement of Snellen visual acuity, a complete ophthalmic exam, and grading of iris neovascularization (Teich and Walsh) and iris angiography (Ehrenberg).

The patients in the study were aged 41 to 85 years. The pathologies associated with the iris neovascularization included proliferative diabetic retinopathy (11 eyes), central retinal vein occlusion (three eyes), central retinal artery occlusion (one eye), and proliferative vitreoretinopathy (one eye). Available follow-up ranged from 6 to 36 weeks with a median of 24 weeks.

Median visual acuity prior to treatment ranged from no light perception to 20/30 (median, hand motion). At last follow-up, median visual acuity had improved to 20/200. Lack of standardized visual acuity measurements represented another limitation of the study, however, Dr. Chalam said.

All patients had grade 2 to 4 iris neovascularization prior to treatment. The neovascularization resolved within 1 week in nine eyes and within 2 weeks in 14 eyes.

Iris angiography could be performed in 12 eyes and showed complete resolution of the neovascularization in six eyes. Four eyes benefited with a 2-grade improvement, and a 1-grade change occurred in two eyes.

In the nine eyes with neovascular glaucoma, defined by an IOP greater than 24 mm Hg, mean IOP prior to the intracameral injection was 51 mm Hg. At last visit, eight eyes were receiving maintenance treatment with maximum medical therapy, one had undergone shunt placement, and mean IOP was 17.5 mm Hg.

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