Intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma

Objective To explore the efficacy and complication of intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma (NVG). Methods NVG patients received the treatment of intravitreal bevacizumab 0.05mL/1.25mg and Ahmed glaucoma valve implantation were retrospectively selected. Subjects received ocular examinations before operation and routine follow-ups after operation, and information including the number of anti-glaucoma medications,Snellen visual acuity and IOP measured by Goldmann applanation tonometer was recorded. Success was defined as an IOP between 6-2lmmHg, without any or with no more additional anti-glaucoma medications, no need of additional glaucoma surgery, and none loss of light perception. Results Thirty-five cases (35eyes) were included and follow up time was 24.6:± 14.2m. Afier Ahmed valve implantation, IOP was decreased compared with pre-IOP (P <0.01), of which were 44.9± 4.8mmHg (pre-op),.18.2± 4.0mmHg (6 m), 15.5± 3.3mmHg (1 y) and 9.8± 2.6mmHg (3 y). The number of anti-glaucoma medications was decreased compared with pre-number (P ＜0.01), of which were 3.3± 0.5(pre-op), 0.9± 0.5 (6 m), 0.8± 0.9 (1 y) and 0.8± 0.6 (3 y). At last follow up, there were 19 cases (54.3%) with stable visual acuity, 4 cases (11.4%) with visual improvement, 12 cases (34.3%) with worse visual acuity, 3 (8.6%) loss light perception. There were 7 cases (20.0%) failed during 3-year follow up period. The cumulative survival rates were 82.9% (1 y), 74.1% (2 y) and 71.0%(3 y) respectively by Kaplan-Meier sruvival analysis. Cox stepwise regression analysis found that the survival time was significant associated with the preop-visual acuity ＜2/400 (RR=3.571, P ＜0.05). Post-op complications occurred in 8 eyes (22.9%), of which hyphema in 2 eyes (5.7%), choroidal effusion in 2 eyes (5.7%). Other complications occurred infrequently and implants were not removed in any of the patients. Conclusions Being safe and effective, the procedure of intravitreal bevacizumab and Ahmed glaucoma valve implantation should be one of treatments to NVG. Key words: Ahmed glaucoma valve;  Neovascular glaucoma;  Bevacizumab;  Intravitreal injection