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Kim, Jeong, You, and Lee: Effect of Simultaneous Intravitreal Bevacizumab and Retrobulbar Triamcinolone Injection in Refractory Neovascular Glaucoma
Original Article

J Korean Ophthalmol Soc 2010;51(4):568-574.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.568

Effect of Simultaneous Intravitreal Bevacizumab and Retrobulbar Triamcinolone Injection in Refractory Neovascular Glaucoma

Woo-Jin Kim, MD, Jin-Gu Jeong, MD, In-Cheon You, MD, Dong-Wook Lee, MD

Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to Dong-Wook Lee, MD Department of Ophthalmology, Chonbuk National University Medical School & Hospital San2-20, Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea Tel: 82-63-250-2306, Fax: 82-63-250-1960 E-mail: ldw@chonbuk.ac.kr

Received 9 October 2009       Accepted 29 December 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To identify the regression of neovascularization and relief of other symptoms after intravitreal bevacizumab and retrobulbar triamcinolone injection in neovascular glaucoma patients with no possibility of visual acuity recovery.

Methods

A total of 15 eyes in 15 patients with neovascular glaucoma, who had no possibility of visual acuity recovery and could not be treated with surgical intervention despite pain from October 2008 to May 2009, were reviewed retrospectively. Changes in degree of pain, conjunctival injection, revascularization, and visual acuity were evaluated after injection.

Results

Ten of the 15 (67%) neovascular glaucoma patients were male, with a mean age of 62.50±12.79 years. The most common prediposing ocular disease was diabetic retinopathy (9; 60%), and the others were central retinal vein occlusion (4: 26%), central retinal artery occlusion (1; 7%), and uveitis (1; 7%). Change in intraocular pressure was significant (p＜0.001), as were decreases in the degrees of pain and conjunctival injection (p＜0.001, <0.001) after the injections. Regression of neovascularization continued in 13 patients (87%) after two months.

Conclusions

Intravitreal bevacizumab and retrobulbar triamcinolone injection is a safe intervention that can substantially relieve pain experienced by neovascular glaucoma patients.

Keywords: Bevacizumab, Neovascular glaucoma, Triamcinolone

References

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Figure 1.
Patient was asked to check the degree of subjective pain using the visual analogue scale at different visiting time (0; no pain, 10; Worst pain that can imagine). (A) Pre-injection time, (B) One week after injection, (C) One month after injection.
jkos-51-568f1.tif
Figure 2.
Change in and grade of conjunctival injection. (A) Pre-injection state (severe conjunctiva vascular con-gestions and epithelial edema; grade 3), (B) After 1 week (grade 2), (C) After 2 months (grade 0).
jkos-51-568f2.tif
Figure 3.
Change in IOP after intravitreal bevacizumab and retrobulbar triamcinolone injection (p<0.001).
jkos-51-568f3.tif
Figure 4.
Change in pain degree after intravitreal bevacizumab and retrobulbar triamcinolone injection (p<0.001).
jkos-51-568f4.tif
Figure 5.
Change in conjunctival injection after intravitreal bevacizumab and retrobulbar triamcinolone injection (p<0.001).
jkos-51-568f5.tif
Figure 6.
Change in neovascularization. (A) Neovascularization on the pupil margin at pre-injection time. (B) Disappearance of neovascularization on the pupil margin and decreasing corneal epithelial edema after 1 week.
jkos-51-568f6.tif
Table 1.
Characteristics of study population
Characteristics Data
Total patients (n*) 15
   Male 10 (67%)
   Female 5 (33%)
Age (y†) 62.50±12.79
Cause of Neovascular glaucoma (n)  
   Diabetes Mellitus 9 (60%)
   Central retinal vein occlusion 4 (27%)
   Central retinal artery occlusion 1 (7%)
   Uveitis 1 (7%)
Stage of Neovascular glaucoma (n)  
   Open angle glaucoma‡ 5(34%)
   Closed angle glaucoma§ 10(67%)

* n=Number of patients

† y=Years

‡ Open-angle glaucoma: Normal angle structure visible for at least 180°

§ Closed-angle glaucoma: Presence of peripheral anterior synechia for more than 180° or presence of ectropion uvea or presence of hyphema.

Table 2.
Clinical evaluation of BCVA, IOP and neovascularization
Patient Angle BC VA* IOP P† (mm Hg)   NVI‡ (2M)
    Pre-injection 2M†† Pre-injection 1M 2M  
1 Closed LPП LP 46 14 15 Regression
2 Open NLP§ NLP 43 5 8 Regression
3 Closed NLP NLP 39 44 46 Regression
4 Closed NLP NLP 32 23 25 Regression
5 Closed NLP NLP 46 33 34 Regression
6 Closed NLP NLP 40 23 21 Regression
7 Closed NLP NLP 48 42 44 Recurrence
8 Closed NLP NLP 47 38 36 Regression
9 Open HM HM 38 34 32 Regression
10 Closed NLP NLP 35 37 35 Regression
11 Open HM# FC**30cm 28 17 15 Regression
12 Closed NLP NLP 52 42 43 Regression
13 Closed NLP NLP 50 30 28 Recurrence
14 Open 0.1 0.1 40 17 15 Regression
15 Open HM 0.1 23 15 14 Regression

* BCVA=best corrected visual acuity

† IOP=intraocular pressure

‡ NVI=neovascularization of the iris

§ NLP=non light perception

П LP=light perception

# HM=hand motion

** FC=finger count

†† M=month.

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