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Intravitreal ranibizumab as adjuvant treatment for neovascular glaucoma121Figure 2: Right eye of a 56-year-old male with neovascular glaucomasecondary to proliferative diabetic retinopathy, submitted tointravitreal Ranibizumab and trabeculectomy with 0.5% C mitomycin;note the partially encapsulated bleb with good IOP control under oneantiglaucoma medication (6-month follow up)measures included 6-month best correct visual acuity (BCVA)and anti-glaucoma medications to control IOP at 6-month followup (Table 1). All eyes showed regression of rubeosis iridis andIOP control. Visual acuity improved in two eyes, worsened inone eye, and remained stable in two eyes. There were notreatment-related adverse effects.DISCUSSIONThis article describes a consecutive case series of 5 eyes(5 patients) with NVG. Two patients underwent only intravitrealranibizumab injection and obtained IOP control after theprocedure under anti-glaucoma medications. Beutel et al.evaluated the long-term effects of intraocular bevacizumabinjections as adjuvant treatment in patients with neovascularglaucoma and hypothesized that bevacizumab may be beneficialas adjuvant treatment because of its anti-angiogenic properties,its ability to induce new vessels regression and to preventprogression of angular obstruction. (2,3)Three patients underwent trabeculectomy with mitomycinC on the 7th day after the intravitreal ranibizumab injection,with successful IOP control, two eyes without antiglaucomamedication and one under one antiglaucoma medication at 6-month follow up (Figure 2). There are reports that intravitrealbevacizumab injection may be an effective adjunct totrabeculectomy in NVG. (5) Although there was no improvementin visual acuity due to patients’ severe disease, the IOP reductionwas achieved with treatment, which traditionally does not occurwith standard filtering procedures without anti-VEGF.Trabeculectomy for NVG eyes has been described as achallenging treatment with a poor surgical success rate. (1)We are unaware of previous reports using ranibizumab asan adjuvant treatment in patients with neovascular glaucoma.This antibody fragment inhibits all forms of biologically activeVEGF and its use is specifically intraocular, with known localand systemic safety but we should concern about the cost oftherapy and the benefit to the patient.These data suggest that ranibizumab may also be a usefultool in the treatment of this devastating disease. Randomizedclinical trials are necessary to confirm the importance of thisadjuvant therapy for the treatment of NVG.REFERENCES1. Allingham RR, Damji KF, Freedman S, Moroi SE, Shafranov G. Shieldstextbook of glaucoma. 5th ed. Philadelphia, PA: Lippincott Williams& Wilkins; 2005. p. 328-46.2. Parrish R, Hershler J. Eyes with end-stage neovascular glaucoma.Natural history following successful modified filtering operation. ArchOphthalmol.1983;101(5):745-6.3. Beutel J, Peters S, Lüke M, Aisenbrey S, Szurman P, Spitzer MS, YoeruekE; Bevacizumab Study Group, Grisanti S. Bevacizumab as adjuvantfor neovascular glaucoma. Acta Ophthalmol. 2010;88(1):103-9. Commentin Acta Ophthalmol. 2010;88(4):e133.4. Douat J, Auriol S, Mahieu-Durringer L, Ancèle E, Pagot-Mathis V,Mathis A. [Intravitreal bevacizumab for treatment of neovascular glaucoma.Report of 20 cases]. J Fr Ophtalmol. 2009;32(9):652-63.5. Saito Y, Higashide T, Takeda H, Ohkubo S, Sugiyama K. Beneficial effectsof preoperative intravitreal bevacizumab on trabeculectomy outcomesin neovascular glaucoma. Acta Ophthalmol. 2010;88(1):96-102.Corresponding Author:Flavia Gazze TiclyRua Izabel Negrão Bertotti, nº 100 - apto. 112BCEP 13087-508 - Campinas (SP), BrazilTel: (19) 8177-3499email: flaviaticly@yahoo.com.brRev Bras Oftalmol. 2013; 72 (2): 119-21