Intravitreal Ranibizumab for Neovascular Glaucoma: An Interventional Case Series

Y H, Ian Wong

Purpose: To evaluate the efficacy of ranibizumab in treating neovascular glaucoma.

Method: This is a prospective interventional case series comprising 6 eyes (of 6 patients) with refractory neovascular glaucoma (NVG), which were treated with each a single dose of 0.5mg intravitreal ranibizumab (IVR) followed by conventional laser panretinal photocoagulation. Patients were divided into 2 group based on angle status for comparison. Outcomes in terms of regression of iris neovascularisation, reduction in intra-ocular pressure (IOP), reduction in number of anti-glaucoma eyedrops used, and recurrences were compared.

Results: Mean age was 59.0 years. Mean follow up was 23 weeks. Three eyes had open-angle (OAG) (50%), three had close-angle configuration (CAG) (50%). In 5 out of 6 cases (83%), iris neovascularisation (NVI) completely regressed within the first 48 hours after IVR injection. Overall mean IOP dropped from 27.0mmHg pre-IVR to 18.3mmHg at 1-week. Mean anti-glaucoma drops decreased from 4.2 pre-IVR to 2.2 one month after IVR. No recurrences were noted in all cases throughout the initial 3-months, but 2 CAG cases had NVI recurred after the 3 months. Average time to recurrence was 14 weeks. No complications were found relating to the injection of ranibizumab.

Conclusions: Results suggested that intravitreal ranibizumab was useful in inducing regression of NVI, helped control IOP in NVG cases. It may act as a safe adjunct to conventional laser photocoagulation in managing NVG.