Simultaneous Intravitreal and Intracameral Injection of Bevacizumab (Avastin) in Neovascular Glaucoma

Purpose: To report the effects of simultaneous intravitreal and intracameral injection of 1.25 mg bevacizumab (Avastin) in 15 neovascular glaucoma (NVG) cases secondary to iris and/or angle neovascularization. Patients and Methods: The study included 15 eyes of 15 patients (seven women, eight men) with NVG secondary to central retinal vein occlusions (CRVO) or proliferative diabetic retinopathy (PDR). Eight eyes had had CRVO and seven PDR prior to NVG. The severity of neovascularization and peripheric anterior synechiae (PAS) was scored from mild (+) to severe (+++). A total dose of 1.25 mg bevacizumab in 0.05 mL was injected into the vitreous cavity and the same dose of bevacizumab into anterior chamber by sterile 30-gauge needle. Results: After treatment neovascularizations on iris and angle were completely resolved 36 h after injection in all patients. Intraocular pressure (IOP) was decreased under 22 mmHg in six cases without any medication. Six cases need medical treatment to achieve appropriate IOP level. Surgical procedure was necessary in three patients who persist high IOP levels despite completely resolved neovascularizations. Conclusions: Simultaneous intravitreal and intracameral injection of bevacizumab can cause an immediate regression of neovascularization secondary to PDR or CRVO and could be an useful adjuvant to prevent dense PAS formation that lead to persistent IOP increasing.