Combined Trabeculectomy with Beta Irradiation with and without Intravitreal Bevacizumab for Neovascular Glaucoma

Abstract

Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) and adjunctive Strontium-90 (Sr90) beta radiotherapy with trabeculectomy  in the management of  neovascular glaucoma (NVG).    Methods: Thirty seven eyes with NVG were randomly selected and divided into two groups according to the treatment given Group 1: Trabeculectomy with Beta-irradiation (n=18 eyes).  Group 2: Preoperative (IVB) followed after two weeks by trabeculectomy and Beta-irradiation (n=19 eyes).  Intraocular pressure (IOP), and regression of rubiosis iridis (NVI) are the used outcome measures.    Results:  By 6 months postoperatively, the mean IOP levels decreased from 38.6mmHg pre-operatively to 11.3mmHg on the first postoperative week and 16.2 at the end of follow up for all cases. No significant difference between both groups as regard of success, while group 2 (IVB) showed more regression of NVI and less incidence of complications. Conclusion: Preoperative IVB combined with filtration surgery and adjuvant Strontium-90 (Sr90) beta radiotherapy is a safe and effective method of controlling intraocular pressure in NVG.