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Editors Selection IGR 17-1
Medical Treatment: Anti-VEGFs for Neovascular Glaucoma
Comment by Nitin Anand on:
61074 Aflibercept for the treatment of neovascular glaucoma, Soohoo JR; Seibold LK; Pantcheva MB et al., Clinical and Experimental Ophthalmology, 2015; 43: 803-807
Anti-VEGFs have revolutionized the management of anterior segment neovascularization and attendant glaucoma. The authors investigated the effect of intravitreal aflibercept, the latest anti-VEGF, in four diabetic patients with iris new vessels and open angles (neovascular glaucoma stage 1 and 2). Aflibercept has several advantages over earlier anti-VEGFs, like bevacuzimab, commonly used for regression of anterior segment neovascularization. It is a more potent inhibitor of VEGF due to its superior binding affinity and pharmacokinetics. It inhibits both VEGF and PIGF, which have been shown to act synergistically in pathological new vessel formation. The disadvantage is the additional cost compared to bevacuzimab.
In the study, patients were to receive one injection at time of diagnosis, at four and eight weeks and then every eight weeks thereafter until 52 weeks. One patient had three aflibercept injections, before refusing further intervention. Iris new vessels regressed in all four cases. No patient required additional intervention and IOP remained well-controlled.
As the authors have pointed out, it was an open-label study with no controls. It is possible that the neovascular process may have been arrested with better control of diabetes alone. As well, the optimum dosage schedule remains unclear. Nevertheless, they have pushed the door open for intravitreal aflibercept to be an alternative for the treatment of NVG.
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