Comparision between Simultaneous Intracameral and Intravitreal Injection and Intravitreal Injection of Bevacizumab in Neovascular Glaucoma

Hyoun Do Huh; Yong Seop Han; In Young Chung; Seong Wook Seo; Jong Moon Park; Ji Myong Yoo; Seong Jae Kim

doi:10.3341/jkos.2014.55.7.1039

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Huh, Han, Chung, Seo, Park, Yoo, and Kim: Comparision between Simultaneous Intracameral and Intravitreal Injection and Intravitreal Injection of Bevacizumab in Neovascular Glaucoma

Original Article

J Korean Ophthalmol Soc 2014;55(7):1039-1048.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.7.1039

Comparision between Simultaneous Intracameral and Intravitreal Injection and Intravitreal Injection of Bevacizumab in Neovascular Glaucoma

Hyoun Do Huh, MD¹, Yong Seop Han, MD, PhD^1,², In Young Chung, MD, PhD^1,², Seong Wook Seo, MD, PhD^1,², Jong Moon Park, MD, PhD^1,², Ji Myong Yoo, MD, PhD^1,², Seong Jae Kim, MD, PhD^1,^2,

¹Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Seong Jae Kim, MD, PhD, Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 660-702, Korea, Tel: 82-55-750-8468, Fax: 82-55-758-4158, E-mail: Maya12kim@naver.com

Received 25 January 2014 Revised 24 February 2014 Accepted 24 June 2014

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 compare the clinical efficacy of simultaneous intracameral and intravitreal injection and intravitreal single injection of bevacizumab in patients with neovascular glaucoma (NVG).

Methods

The medical records of 43 eyes of 43 patients, who had treated with simultaneous intracameral and intravitreal injection (Group I) or intravitreal single injection (Group II) of bevacizumab 1.25 mg from January 2010 to December 2012, were retro- spectively reviewed. The best corrected visual acuity (BCVA), intraocular pressure (IOP), regression time of new vessel in the iris (NVI) and anterior chamber angle (NVA), progression of peripheral anterior synechiae (PAS), and corneal parameters were measured preoperatively and one day, three days, 1 week, 1 month, and 3 months postoperatively.

Results

There was significant changes of IOP between the two groups at 1, 3 days postoperatively (p = 0.001, p < 0.001). The regression time of NVI and NVA in Group I was significantly faster than Group II (p = 0.026, p = 0.033). In the phakic eyes, regression time of NVI and NVA was significantly longer than aphakic and pseudophakic eyes in group II (p = 0.006, p = 0.005). Also, in the phakic NVG patients, the formation of PAS in Group I was significantly less than in Group II for the postoperative three months (p = 0.020).

Conclusions

Simultaneous intravitreal and intracameral injection of bevacizumab seem to be more effective for the early lowering of IOP and regression of NVI and NVA, and inhibiting further PAS formation in NVG patients, especially in the phakic eyes. Therefore, simultaneous intracameral and intravitreal injection of bevacizumab may be considered as an adjunct to management of NVG in the phakic eyes.

Keywords: Bevacizumab, Intraocular pressure, Lens, Neovascular glaucoma, Peripheral anterior synechiae

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Figure 1.

IOP difference between post-injection and pre-injection in both groups. Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group. IOP = intraocular pressure. *Paired t-test, p-value < 0.05.

Table 1.

Demographics of enrolled patients

	Group I (n = 23)	Group II (n = 21)	p-value	Total (n = 44)
Age (years)	58.7 ± 9.9	60.5 ± 8.8	0.556^*	59.9 ± 9.2
Sex (n)
Male	14	16		30
Female	9	5	0.731^†	14
Underlying diseases (n)
DM	14	14		28
HTN	3	2		5
DM and HTN	6	5	0.668^†	11
Preoperative diagnosis (n)
PDR	16	17		33
CRVO	7	4	0.672^†	11
Lens status (n)
Phakia	12	12		24
Pseudophakia	9	8		17
Aphakia	2	1	0.805^†	3
PAS (n)
None	11	8		20
Mild	4	1		5
Moderate	3	1		4
Severe	2	5		7
Very severe	3	5	0.374^†	8
Ahmed valve implant surgery (n)	5	7	0.425^*	12

Values are presented as mean ± SD; Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group; PAS range: none = 0°, 0° < mild ≦ 90°, 90° < moderate ≦ 180°, 180° < severe ≤ 270°, 270° < very severe ≦ 360°.

DM = diabetic mellitus; HTN = hypertension; PDR = proliferative diabetic retinopathy; CRVO = central retinal vein occlusion; PAS = peripheral anterior synechiae.

^* Paired t-test;

^† Fisher's exact test.

Table 2.

Change of visual acuity between pre-injection and post-injection 3 months later in both groups

	Group I (n = 23)	Group II (n = 21)	p-value^†	Total (n = 44)
Better (n)	4	5		9
Same (n)	18	15		33
Worse (n)	1	1		2
p-value^*	0.658	0.624		0.638
Δ VA (mean ± SD, n)	0.22 ± 0.36	0.24 ± 0.32	0.882	0.23 ± 0.34

Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group.

SD = standard deviation; ΔVA = visual acuity difference between pre-injection and post-injection after 3 months (visual acuity range: 1 = counting fingers or worse, 2 = 0.01-0.1, 3 = 0.2-0.5, 4 = 0.6-1.0).

^* ANOVA test;

^† Paired t-test.

Table 3.

Change of IOP and number of IOP lowering medications in pre-injection and 3 months after injection in both groups

		Group I(^*n = 18)	Group II(^*n = 14)	p-value	Total (n = 32)
IOP (mm Hg)	Pre-op	36.0 ± 4.1	34.9 ± 4.2	0.637	35.4 ± 7.6
	Post-op 1 day	26.5 ± 4.8	29.3 ± 3.1	0.385	27.9 ± 7.6
	Post-op 3 days	20.1 ± 3.4	27.4 ± 3.3	0.042^†	23.7 ± 7.8
	Post-op 1 week	18.8 ± 3.7	23.0 ± 3.2	0.208	20.9 ± 7.7
	Post-op 1 month	15.9 ± 3.6	16.0 ± 3.8	0.935	16.0 ± 3.6
	Post-op 3 months	14.4 ± 2.5	16.0 ± 2.4	0.230	15.2 ± 2.6
IOP lowering medications (n)	Pre-op	3.00 ± 0.0	2.91 ± 0.3	0.164	2.96 ± 0.2
IOP lowering medications (n)	Post-op 3 months	2.47 ± 0.4	2.36 ± 1.1	0.189	2.42 ± 0.6

Values are presented as mean ± SD; Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group.

IOP = intraocular pressure; Pre-op = pre-injection; Post-op = post-injection.

^* Number of patient exception Ahmed valve implant surgery received;

^† Paired t-test, p-value < 0.05.

Table 4.

Comparison of regression time of NVI and NVA in both groups

	Group I (n = 23)	Group II (n = 21)	p-value	Total (n = 44)
Regression time of NVI (days)	3.1 ± 1.2	3.9 ± 1.6	0.026^*	3.5 ± 1.5
Regression time of NVA (days)	3.2 ± 1.4	4.0 ± 1.5	0.033^*	3.6 ± 1.5

Values are presented as mean ± SD; Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group.

NVI = neovascular iridis; NVA = neovascular angle.

^* Paired t-test, p-value < 0.05.

Table 5.

Comparison of regression time of NVI and NVA according to lens status in both groups

		Phakia (Group I: n = 12, Group II: n = 12)	Pseudophakia (Group I: n = 9, Group II: n = 8)	Aphakia (Group I: n = 2, Group II: n = 1)	p-value^‡
Regression time of NVI (day)	Group I	3.2 ± 1.4	3.1 ±1.0	2.0 ± 0.5	0.291
	Group II	4.2 ± 1.9	3.3 ± 1.3	2.0 ± 0.0	0.006^†
	p-value^*	0.01^†	0.565	1.000
Regression time of NVA (day)	Group I	3.2 ± 1.3	3.1 ± 1.4	2.0 ± 0.5	0.242
	Group II	4.2 ± 1.9	3.4 ± 1.5	2.0 ± 0.0	0.005^†
	p-value^*	0.009^†	0.549	1.000

Values are presented as mean ± SD; Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group.

NVI = neovascular iridis; NVA = neovascular angle.

^* Paired t-test;

^† p-value < 0.05;

^‡ ANOVA test.

Table 6.

Change of corneal parameters in pre-injection and 3 months after injection in both groups

		Group I (^*n = 18)	Group II (^*n = 14)	p-value^†	Total (n = 32)
ECC	Pre	2380.60 ± 278.95	2444.8 ± 360.50	0.342	2389.20 ± 322.42
	Post	2264.65 ± 257.45	2377.05 ± 360.95	0.442	2319.85 ± 310.20
	p-value^†	0.228	0.364		0.569
	Δ ECC	77.95	67.75	0.064
CV	Pre	17.50 ± 5.87	18.55 ± 3.76	0.537	18.03 ± 4.90
	Post	15.60 ± 5.42	16.75 ± 5.76	0.418	16.18 ± 5.70
	p-value^†	0.210	0.256		0.309
	Δ CV	1.9	1.8	0.602
Hexa	Pre	51.89 ± 4.19	53.39 ± 2.65	0.290	52.64 ± 3.54
	Post	51.20 ± 4.18	52.64 ± 3.60	0.349	51.91 ± 3.92
	p-value^†	0.685	0.630		0.627
	Δ Hexa	0.69	0.75	0.598
Pachy	Pre	620.64 ± 38.53	625.18 ± 26.48	0.671	622.80 ± 32.85
	Post	566.55 ± 36.75	573.81 ± 26.65	0.615	569.03 ± 31.80
	p-value^†	0.014	0.036		0.015
	Δ Pachy	54.09	51.37	0.762

Values are presented as mean ± SD; Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group.

Pre = pre-injection; Post = 3 months after injection; ECC = endothelial cell count (cells/mm2); CV = coefficient of variation; Hexa = hexagonality (%); Pachy = pachymetry (um); Δ = difference between pre-injection and 3 months after injection.

^* Number of patient exception Ahmed valve implant surgery received;

^† Paired t-test.

Table 7.

PAS change according to lens status in both groups

		Phakia(Group I: n = 12 Group II: n = 12)	Pseudophakia(Group I: n = 9 Group II: n = 8)	Aphakia(Group I: n = 2 Group II: n = 1)	p-value^‡	Total (n = 44)
Preop PAS	Group I	1.12 ± 0.45	1.00 ± 0.56	3.00 ± 0.00	0.112	2.12 ± 0.74
Preop PAS	Group II	1.22 ± 0.76	2.42 ± 0.66	4.00 ± 0.00	0.142	3.64 ± 0.82
Postop PAS	Group I	1.83 ± 0.52	1.69 ± 0.58	3.00 ± 0.00	0.346	3.52 ± 0.61
Postop PAS	Group II	2.03 ± 0.82	3.14 ± 0.64	4.00 ± 0.00	0.052	5.17 ± 0.73
Δ PAS	Group I	0.71 ± 0.12	0.69 ± 0.09	0	0.650	0.70 ± 0.18
	Group II	0.81 ± 0.18	0.72 ± 0.12	0	0.262	0.76 ± 0.15
	p-value^*	0.020^†	0.317			0.068

Values are presented as mean ± SD; Group I: simultaneous intravitreal and intracameral bevacizumab injection group; Group II: intravitreal bevacizumab injection group.

PAS = peripheral anterior synechiae (PAS range: 0 = 0°, 0° < “1” ≦ 90°, 90° < “2” ≦180°, 180° < “3” ≦ 270°, 270° < “4” ≦ 360°); Pre-op = pre-injection; Post-op = post-injection at 3 months; ΔPAS = PAS difference between pre-injection and 3 months after injection.

^* Paired t-test;

^† p-value < 0.05;

^‡ ANOVA test.

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