Clinical Outcome of Preoperative Intravitreal Bevacizumab Followed by Trabeculectomy with Mitomycin C for Treatment of Neovascular Glaucoma

Purpose: Trabeculectomy for Neovascular Glaucoma (NVG) is regarded as a challenging treatment with relatively poor success. Regression of anterior segment neovascularization preoperatively with intravitreal Bevacizumab (IVB) has lower likelihood of postoperative complications and failure of Trabeculectomy. We investigated the effectiveness of IVB on outcome of augmented Trabeculectomy in treatment of NVG. Methods: 26 eyes of 24 subjects with refractory NVG were retrospectively analyzed. All patients had received IVB at least 1 week prior to augmented Trabeculectomy performed by a single surgeon. Average postoperative follow-up was 10 months. The main and secondary outcome measures were postoperative intraocular pressure (IOP) and visual acuity (VA) respectively. ‘Complete’ surgical success was defined as an IOP of 21mmHg. Informed consent was obtained from all patients after discussion about the potential benefits and risks of Bevacizumab and Trabeculectomy with MMC. Patients with uncontrolled IOP on maximum tolerable medical therapy requiring filtering surgery and who underwent at least a single dose of preoperative IVB were included in the study. Those in whom IOP could not be recorded due to scarred corneas, or those who had undergone other IOP lowering procedures prior to Trabeculectomy, and those who were lost to follow-up were excluded from the study.