Korean J Ophthalmol.  2009 Sep;23(3):188-192. 10.3341/kjo.2009.23.3.188.

Concentration of Vascular Endothelial Growth Factor After Intracameral Bevacizumab Injection in Eyes With Neovascular Glaucoma

• Lim TH
• Bae SH
• Cho YJ
• Lee JH
• Kim HK
• Sohn YH

• KMID: 1115751
• DOI: http://doi.org/10.3341/kjo.2009.23.3.188

Abstract

PURPOSE
To study the concentration of vascular endothelial growth factor (VEGF) in the aqueous humor before and after intracameral injection of bevacizumab in eyes with neovascular glaucoma, and to detect the duration of an anti-VEGF effect of bevacizumab in the anterior chamber. METHODS: In this prospective interventional case series, 1.25 mg of bevacizumab was injected into the anterior chamber of five eyes in five neovascular glaucoma patients. Aqueous humor samples were obtained just before intracameral injection of bevacizumab and two weeks after injection. The concentrations of VEGF in the aqueous humor were measured using ELISA. To investigate corneal endothelial damage after intrecameral bevacizumab injection, specular microscopy was performed before injection and two weeks after injection. Slit lamp photo and iris fluorescent angiography was performed to determine the regression of iris neovascularization. RESULTS: After injection, substantial regression of neovascularization or fluorescein leakage was seen in all treated eyes. The VEGF concentrations in the aqueous humor in eyes with NVG were 1181.8+/-1248.3 pg/mL before intracameral injection of bevacizumab. Two weeks after injection, the VEGF concentrations decreased to 33.2+/-12.2 pg/mL (p=0.04, Wilcoxon signed rank test). There were no significant changes in IOP or corneal endothelial cells. CONCLUSIONS: Intracameral bevacizumab injection can remarkably reduce iris neovascularization in neovascular glaucoma patients. VEGF levels were significantly decreased two weeks after injection and corneal toxicity was not observed during short term follow-up.

Keyword

Bevacizumab; Intracameral injection; Neovascular glaucoma; Vascular endothelial growth factor

MeSH Terms

Adult
Aged
Aged, 80 and over
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Aqueous Humor/*metabolism
Eye
Glaucoma, Neovascular/*drug therapy/*metabolism
Humans
Injections
Middle Aged
Osmolar Concentration
Prospective Studies
Vascular Endothelial Growth Factor A/antagonists & inhibitors/*metabolism

Figure

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  Fig. 1 Vascular endothelial growth factor (VEGF) in the aqueous humor of eyes with neovascular glaucoma. VEGF levels are shown before intracameral bevacizumab injection (pre-bevacizumab), two weeks after injection (post-bevacizumab) and for the control group.

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  Fig. 2 (A) A NVG patient showing iris neovascularization before bevacizumab injection. (B) Two weeks after intracameral bevacizumab injection, neovascularization had completely regressed.

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  Fig. 3 (A) Iris fluorescein angiogram shows marked dye leakage from rubeotic vessels before intracameral vevacizumab injection. (B) Two weeks after intracameral bevacizumab injection, the leakage from iris neovascularization was remarkably decreased.

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