The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma

Ling Bai, Yanfen Wang, Xindi Liu, Yuping Zheng, Wenjing Wang, Na He, Farheen Tariq, Feng Wang, Shu Zhang, Ling Bai, Yanfen Wang, Xindi Liu, Yuping Zheng, Wenjing Wang, Na He, Farheen Tariq, Feng Wang, Shu Zhang

Abstract

This study investigates the safety and efficacy of conbercept injection through different routes for neovascular glaucoma (NVG) treatment, in which seventy-four patients (81 eyes) with NVG caused by ischemia retinopathy had participated. Patients were divided into three stages according to the progression of NVG and were randomly assigned to receive intracameral or intravitreal conbercept injection. After conbercept injection, patients experienced improved best-corrected visual acuity (BCVA), good intraocular pressure (IOP) control, and neovascularization of Iris (NVI) regression. In stage III, patients required trabeculectomy with mitomycin C plus pan-retinal photocoagulation (PRP) to achieve complete NVI regression. Compared to the intravitreal group, the intracameral group had significantly lower IOP in 2 days in stage III and 1 day in stages I and II after injection, complete NVI regression before PRP in stages I and II, and better NVI regression in stage III. The rates of hyphema after trabeculectomy and malfunction filtering bleb suffering needle bleb revision were lower in the intracameral group, but only the hyphema rate was significantly different. Injections through different routes are all safe. We recommend intravitreal injections for patients in stages I and II, but for stage III, intracameral injection is better, and trabeculectomy with mitomycin C should be conducted within 2 days after injection to maximally reduce the risk of perioperative hyphema. Trial Registration: ClinicalTrials.gov, identifier NCT03154892.

Keywords: anti-VEGF therapy; anti-glaucoma surgery; glaucoma; neovascular glaucoma; pan-retinal photocoagulation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Bai, Wang, Liu, Zheng, Wang, He, Tariq, Wang and Zhang.

Figures

Figure 1
Figure 1
Intraocular pressure profile following conbercept intracameral/intravitreal injection for NVG. *Indicates p < 0.05. NVG, neovascular glaucoma.
Figure 2
Figure 2
The optimized therapeutic regimen for neovascular glaucoma. Phaco, Phacoemulsification; PPV, Pars plana vitrectomy; EL, Endolaser; PRP, Pan-retinal photocoagulation.
Figure 3
Figure 3
Ophthalmic examination of a typical case. (A–C) Before treatment, yellow arrows indicate NVI and NVA, a green arrow indicates bleeding at the angle; (D) 1 day after conbercept injection; (E) 2 days after conbercept injection; (F) 3 days after trabeculectomy with mitomycin C, blue arrow indicates filtering bleb; (G) 6 months after conbercept injection; (H) the completion of extra-PRP. PRP, Pan-retinal photocoagulation; NVI, neovascularization of Iris; NVA, neo-vessel at the anterior chamber angle.

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