Adverse events associated with intraocular injections of bevacizumab in eyes with neovascular glaucoma.

BACKGROUND: Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), has been reported to cause rapid regression of anterior segment neovascularization in eyes with neovascular glaucoma when administered intraocularly. Several studies have reported the safety profile of intravitreal injections of bevacizumab in patients with various retinal pathologies. We investigated the occurrence of adverse events associated with intraocular bevacizumab injections in patients with neovascular glaucoma. METHODS: We retrospectively reviewed the charts of 84 eyes of 70 patients with neovascular glaucoma that received intraocular bevacizumab injections to treat anterior segment neovascularization for the first time at Kanazawa University Hospital. RESULTS: The mean age of the patients was 63.5 ± 13.3 years (± standard deviation; range, 31-85 years). The underlying retinal diseases were proliferative diabetic retinopathy in 58 eyes (69%), central retinal vein occlusion in 17 eyes (20%), ocular ischemic syndrome in four eyes (5%), central retinal artery occlusion in three eyes (4%), branch retinal vein occlusion in one eye (1%), and radiation retinopathy in one eye (1%). The total number of intraocular injections of bevacizumab was 116 (1.4 ± 0.8 injections/eye, range, one to five injections/eye). Most were intravitreal injections (1.25 mg/0.05 ml; 115 injections, 99%). No cases had marked inflammation, lens injuries, marked vitreous hemorrhage, retinal detachment, or endophthalmitis. However, two eyes (2%) of two cases (3%) developed central retinal artery occlusion 3 or 4 days after bevacizumab injection. Both were among four eyes (i.e., 50%) with ocular ischemic syndrome. One of them had received an intracameral injection of bevacizumab (0.75 mg/0.03 ml) before the adverse event. No cases experienced systemic side-effects including myocardial infarction and cerebrovascular accidents within 3 months after bevacizumab injection. CONCLUSIONS: Central retinal artery occlusion may be a relatively common complication following intraocular injection of anti-VEGF agents in patients with neovascular glaucoma, particularly when it was associated with ocular ischemic syndrome. Since visual prognosis of central retinal artery occlusions is usually poor, intraocular injection of anti-VEGF agents should be performed with thoughtful consideration of the risks and benefits of the treatment, and with a strict follow-up examination, especially in high-risk patients.

Cystoid macular edema associated with oral antineoplastic agent s-1 in a patient with diabetic retinopathy.

A 60-year-old man with neovascular glaucoma due to diabetic retinopathy received an intravitreal injection of 1.25 mg bevacizumab (IVB) followed by extensive panretinal photocoagulation in the right eye. The anterior segment neovascularization regressed within 10 days after IVB. One and a half months later, the patient underwent gastrectomy for stage IIIb gastric cancer. Two months later, he was started on S-1 orally (100 mg/day for 48, 26, and 32 consecutive days in the first, second, and third treatment cycle, respectively). The interval between the first and second treatment cycle was 20 days and between the second and third cycle it was 24 days. The patient developed anemia and diarrhea. At the end of the second S-1 cycle, cystoid macular edema developed in the right eye, although diabetic retinopathy and neovascular glaucoma were stable. Macular edema persisted for 5 months despite another IVB, and disappeared 3 months after termination of S-1 therapy. The time course of the magnitude of macular edema correlated well with the severity of anemia. The macular edema was possibly associated with anemia, which is a major side effect of S-1. Further studies are warranted to investigate the relationship between anemia and macular edema in patients with diabetic retinopathy.

Relationship between macular ganglion cell complex parameters and visual field parameters after tumor resection in chiasmal compression.

PURPOSE: To evaluate the relationship between macular ganglion cell complex (GCC) parameters and visual field (VF) parameters in chiasmal compression and the potential for GCC parameters in order to predict the short-term postsurgical VF. METHODS: Twenty-three eyes of 12 patients with chiasmal compression and 33 control eyes were studied. All patients underwent transsphenoidal tumor resection. Before surgery a 3D scan of the macula was taken using spectral-domain optical coherence tomography. All patients underwent Humphrey 24-2 VF testing after surgery. Spearman's rank correlation coefficients were used to evaluate the relationship between the GCC parameters and VF parameters [mean deviation (MD), pattern standard deviation]. Coefficients of determination (R2) were calculated using linear regression. RESULTS: Average thickness in the patients was significantly thinner than that of controls. Average thickness, global loss volume and focal loss volume (FLV) significantly correlated with the MD. We observed the greatest R2 between FLV and MD. CONCLUSIONS: Examining the macular GCC was useful for evaluating structural damage in patients with chiasmal compression. Preoperative GCC parameters, especially FLV, may be useful in predicting visual function following surgical decompression of chiasmal compression.

Clinical factors related to recurrence of anterior segment neovascularization after treatment including intravitreal bevacizumab.

PURPOSE: To investigate the impact of clinical factors on the recurrence of anterior segment neovascularization after intravitreal bevacizumab injection. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Charts of 54 eyes of 54 consecutive patients who received intravitreal bevacizumab injections (1.25 mg) for the treatment of anterior segment neovascularization were reviewed. The mean follow-up period +/- standard deviation was 16 +/- 8 months (range, 4 to 31 months). For eyes with incomplete panretinal photocoagulation, additional retinal ablation was performed within 1 month after bevacizumab injection. Differences in clinical factors were compared between eyes with and without recurrence. Baseline clinical factors were age, gender, predisposing diagnosis, status and clinical stages of anterior segment neovascularization, fundus neovascularization, visual acuity, baseline intraocular pressure, previous retinal ablation, previous intraocular surgeries, lens status, history of glaucoma, hemoglobin A1c level, hypertension, and creatinine level. Factors after intravitreal bevacizumab administration were additional retinal ablation, intraocular surgeries, mean intraocular pressure until recurrence, and visual acuity. Univariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the contribution of these factors to recurrence. Kaplan-Meier survival analysis with the log-rank test was performed with recurrence as the end point. RESULTS: Recurrence occurred in 26 (48%) eyes a mean +/- standard deviation of 4.7 +/- 3.0 months (range, 2 to 11 months) after bevacizumab injection. Multivariate analysis identified trabeculectomy after bevacizumab injection as the primary inhibitory factor for recurrence (hazard ratio, 0.23; 95% confidence interval, 0.094 to 0.55; P = .001). Kaplan-Meier survival analysis showed that trabeculectomy after bevacizumab injection provided a significantly better survival rate (P < .001). CONCLUSIONS: Recurrence of anterior segment neovascularization after intravitreal bevacizumab injection occurs despite intensive retinal ablation: trabeculectomy may suppress recurrence.