intravitreal bevacizumab in neovascular glaucoma; a randomized clinical trial

purpose: to determine the effect of intravitreal bevacizumab (ivb) on neovascular glaucoma (nvg) in terms of intraocular pressure (iop), iris neovascularization (nvi) and best-corrected visual acuity (bcva). methods: in this randomized controlled trial, 26 eyes of 26 patients with nvg receiving conventional treatment were randomly allocated to three 2.5 mg ivb injections at 4-week intervals or a sham procedure (subconjunctival normal saline) at similar time intervals and in the same setting. changes in iop, extent of nvi and bcva were compared between the two groups. results: overall, 14 eyes of 14 patients received ivb and 12 eyes of 12 subjects were allocated to the sham procedure and followed for a mean period of 5.9±1.4 months. the study arms were balanced regarding age, sex, cause of nvg, bcva, iop, and extent of nvi. the ivb group demonstrated significant reduction in mean iop from a baseline value of 33.4±14.5 mmhg to 21.8±13.7 mmhg (p=0.007), 25.1±20.0 mmhg (p=0.058) and 23.9±18.7 mmhg (p=0.047) one, three and six months after intervention respectively. mean nvi was also significantly reduced from a mean baseline value of 347±48° to 206±185° (p=0.01), 180±187° (p=0.004) and 180±180° (p=0.004) one, three and six months after intervention respectively. mean iop in the sham group was 32.3±14.3 mmhg prior to intervention and 34.9±15.2 mmhg (p=0.046), 35.2±10.7 mmhg (p=0.29) and 32.2±7.3 mmhg (p=0.92) at one, three and six months after the injection respectively. mean nvi in the sham group increased insignificantly from a baseline value of 270±138° to 277±130° (p=0.34), 300±117° (p=0.22) and 324±114° (p=0.34) one, three and six months after intervention respectively. no significant change in bcva was observed within the study groups at any time interval. conclusion: intravitreal injections of bevacizumab seem to significantly reduce the extent of nvi and iop in neovascular glaucoma, but may not affect visual acuity.