Intravitreal Bevacizumab for Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma: A Case Report

Nisa Sothornwit MD*

Affiliation : *Department of Ophthalmology, Priest Hospital

Objective : To report the short-term efficacy and safety of intravitreal Bevacizumab injection in conjunction with implantation of Ahmed glaucoma valve in a patient with refractory neovascular glaucoma (NVG) caused by proliferative diabetic retinopathy (PDR). Material and Method: A patient with NVG and vitreous hemorrhage caused by PDR was initially treated with 1.25 mg intravitreal Bevacizumab injection. One week after injection, intraocular pressure (IOP) did not improve with partial regression of the anterior segment new vessels. The patient underwent pars planar vitrectomy with panretinal photocoagulation (PRP) combined with trabeculectomy. Despite the initial good response, the patient developed recurrent hyphema and vitreous hemorrhage with uncontrolled IOP on full medications. Ahmed glaucoma valve implantation combined with the second intravitreal injection of 1.25 mg Bevacizumab was performed.
Results : At 48 hours postoperative, IOP markedly decreased. Iris neovascularization was not visible. The rapid resolution of hyphema and vitreous hemorrhage was noted. At 6 weeks follow-up, the patient gained visual acuity (VA) from hand motion to 20/100. The IOP was 8 mmHg with no recurrence of iris rubeosis. Vitreous hemorrhage had cleared revealed the view of fundus with full PRP and no new retinal vessels. At 8 weeks postoperative, there was small recurrent iris neovascularization without any rise in IOP. No interven- tion was done except careful follow-up. At 3 months, the patient retained VA of 20/100 with the IOP of 9 mmHg. Small iris rubeosis presented with no changes in appearance. No serious ocular or systemic adverse effects occurred after intravitreal Bevacizumab injections. Conclusions: Ahmed glaucoma valve implantation in combination with intravitreal Bevacizumab injection is effective in controlling IOP in refractory neovascular glaucoma. This approach may increase visual outcome in cases with extensive neovascularization, before PRP takes effect, weeks later. The long-term efficacy and safety of this anti-proliferative agent in glaucoma drainage implants still requires further investigation.

Keywords : Bevacizumab, Ahmed glaucoma valve, neovascular glaucoma

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