Pre-trabeculectomy intravitreal injections of Bevacizumab for treating neovascular glaucoma in diabetic patients

Background/Aim. To evaluate the efficacy and safety of intravitreal injections of Bevacizumab before trabeculectomy with mitomycin C (MMC) for treatment of neovascular glaucoma (NVG). Methods. A prospective and open-label study, from May 2013 to December 2014, was conducted on consecutive NVG patients who underwent intravitreal injections of Bevacizumab and a primary trabeculectomy with MMC. All patients were followed-up at least for 12 months. Success was defined as an intraocular pressure (IOP) of ≤21 mm Hg with or without topical ocular hypotensive medication. Results. Fourteen eyes of 12 diabetic patients fulfilled the respective demands of the inclusion and exclusion criteria. The mean (standard deviation) follow-up period was 15.0 (2.0) months (range, 12 to 19 months). After one year of follow-up, 11 (78.6%) eyes had an IOP ≤ 21 mmHg. The mean IOP was significantly reduced from 42.4 (9.7) mmHg preoperatively to 18.4 (2.9) postoperatively, p<0.0001. Regarding surgical complications, hyphaema was observed in 3 (21.4%) eyes, macular edema in one eye (7.1%) after 6 months of trabeculectomy, and recurrence of neovascularization requiring intravitreal Bevacizumab injection in 2 eyes (14.2%) after 6 months. Conclusion. Preoperative intravitreal bevacizumab may be effective as adjunctive treatment for trabeculectomy with mitomycin-C for neovascular glaucoma patients.