The efficacy of subconjunctival bevacizumab in the management of rubeosis iridis and neovascular glaucoma

Abstract EN

Objective: to compare the efficacy of Subconjunctival bevacizumab with intra vitreal bevacizumab in eyes with rubeosis iridis and neovascular glaucoma (NVG).

Method: a prospective study conducted at King Hussein Medical Centre and prince Rashid military hospital between December 2016 and June 2018.

All eyes found to have rubeosis iridis or neovascular glaucoma were included in the study.

Eyes with rubeosis iridis alone were divided randomly into 3 groups; group A are those which received intra vitreal 1.25 mg/0.05 ml bevacizumab, Group B are those which received subconjunctival injection of 3.75 mg /0.15 mL bevacizumab and Group C which did not receive bevacizumab.

Eyes with NVG were divided randomly into two groups: those which received subconjunctival injection of 3.75 mg /0.15 mL bevacizumab upon starting IOP lowering agents (group D) and the remaining eyes received anti glaucoma medications without receiving the injection (group E).

Eyes with NVG and scheduled for Ahmed glaucoma valve implant (AGV); half of them were randomly selected to receive subconjunctival injection of 3.75 mg /0.15 mL bevacizumab and the remaining eyes underwent surgery without the use of bevacizumab injection.

All eyes underwent pan retinal photocoagulation (PRP).

The eyes were assessed initially regarding best corrected visual acuity, level of intraocular pressure, degree of rubeosis at 2 weeks, 6 weeks and 3 months after treatment.

Results: Sixty patients (94 eyes) with a mean age of 57.1±8.2 years and male to female ratio of 3:2 were included in the study.

The most commoncauses for rubeosis and NVG were diabetic retinopathy (67%) and retinal vein occlusion (16%).

In eyes with rubeosis alone; at 3 months subconjunctival bevacizumab injection was able to induce regression of rubeosis in 77% of eyes compared with 82% in eyes with intravitreal injection and 62% in eyes that did not receive the injection.

Eyes with NVG which received subconjunctival bevacizumab showed significant improvement in BCVA, more reduction in IOP, better regression of rubeosis and higher success rate Ahmed Glaucoma Valve (AGV) surgery.

Conclusion: Subconjunctival bevacizumab injection was effective as intravitreal route in treating the eyes with rubeosis.

Eyes with neovascular glaucoma showed significant improvement in BCVA, more reduction in IOP, better regression of rubeosis and more success rate of AGV surgery.