Clinical analysis of intravitreal injection of Bevacizumab combined with panretinal photocoagulation and compound trabeculectomy for neovascular glaucoma

Objective To investigate the clinical efficacy of intravitreal injection of Bevacizumab combined with panretinal photocoagulation and compound trabeculectomy for neovascular glaucoma(NVG).Methods A total of 30 NVG patients(30 eyes),who were taken treatment in our hospital from January,2008 to May,2009,were randomly divided into 2 groups.Eighteen patients(18 eyes)were treated with intravitreal injection of 25 mmol·L-1 Bevacizumab combined with panretinal photocoagulation and compound trabeculectomy in group A.Twelve patients(12 eyes)were taken panretinal photocoagulation and Ahmed glaucoma valve implantation in group B.Changes of visual acuity,intraocular pressure(IOP)and iris neovascularization were observed before and after operation in both 2 groups.Structure of angle of anterior chamber was observed with gonioscope.Mitomycin C 0.4 g·L-1 was used in both 2 groups.Results About 2 days to 3 days after intravitreal injection of Bevacizumab,iris neovascularization disappeared in all patients of group A.Panretinal photocoagulation was completed in 4 weeks.Two months after injection,IOP of 18 eyes were higher than 30 mmHg,and angle of anterior chamber was closed.One week after compound trabeculectomy,IOP was 7 mmHg to 12 mmHg.IOP was 10 mmHg to 37 mmHg at postoperative 1 month.Panretinal photocoagulation was completed in 4 weeks in group B.Parts of iris neovascularization were extinct.IOP were 10 mmHg to 16 mmHg and 10 mmHg to 35 mmHg at 1 week and 1 month after Ahmed glaucoma valve implantation.All patients were followed up at postoperative 6 months,there was no statistical difference in IOP control or visual acuity between the two groups(both P0.05).The operative achievement ratio was 83.33% in group A higher than 66.67% in group B.Iris neovascularization was found in 6 eyes of group B and not found in group A,there was statistical difference(P0.05).Conclusion Intravitreal injection of Bevacizumab combined with panretinal photocoagulation and compound trabeculectomy is with high achievement rate,low incidence of complications and significant curative efficacy for NVG.