Simultaneous Ahmed Glaucoma Valve Implantation with Intravitreal and Intracameral Bevacizumab in Refractory Acute Stage of Neovascular Glaucoma: Short-Term Results and Complications

Purpose: To examine the safety and efficacy of simultaneous Ahmed glaucoma valve (AGV) implantation with intravitreal and intracameral injection of bevacizumab (IVB and ICB) in patients with refractory acute neovascular glaucoma (NVG) with very high intraocular pressure (IOP) and active neovascularization of the iris (NVI) and/or the angle (NVA) Methods: In a prospective interventional study, patients presenting with acute NVG with uncontrolled IOP despite maximally tolerated medical treatment and with no prior history of interventions for their ischemic retinal condition underwent AGV implantation and IVB and ICB injection. Their baseline clinical data including the etiology of NVG, visual acuity (VA), IOP and the number of anti-glaucoma medications were recorded. Postoperatively, VA, IOP and number of anti-glaucoma medications and any complications were recorded. The main outcome measure was IOP control with and without medical therapy. Results: Six eyes of 6 patients were recruited in the study. All of them had diabetic NVG. The mean age of the patients was 62.6±7.8 years. Mean IOP and number of medications were 61.5±9.9 mmHg and 4.1±.4, respectively. Three months after the surgery, the mean IOP and the number of medications were 19.5±4.5 mmHg and 2±1.26, respectively. The most frequent complication was hyphema (occurring in all eyes) that resolved spontaneously during the first postoperative week in 5 eyes and necessitated anterior chamber (AC) washout in 1 eye. Postoperatively, two eyes developed choroidal effusions and shallow ACs which resolved without any intervention during the first postoperative month. Conclusion: In patients with acute NVG with no prior treatment whose IOP was very high despite maximal medical therapy, AGV implantation with simultaneous IVB and ICB injection effectively reduced IOP and medications use in short-term. The most frequent complication was development of hyphema (in all eyes) which spontaneously resolved in most eyes.