Anti-vascular endothelial growth factor for neovascular glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Vascular Biology

Background:

• Neovascular glaucoma (NVG) is a severe secondary glaucoma characterized by abnormal blood vessel growth, impeding aqueous humor drainage.
• Anti-vascular endothelial growth factor (anti-VEGF) agents are developed to inhibit neovascularization, showing potential in managing intraocular pressure (IOP) in NVG.
• Existing studies suggest anti-VEGF agents may be effective for IOP control in NVG patients.

Purpose of the Study:

• To compare the efficacy of intraocular anti-VEGF agents versus no anti-VEGF treatment as an adjunct therapy for neovascular glaucoma (NVG).
• To evaluate the intraocular pressure (IOP) lowering effects of anti-VEGF agents in the context of existing NVG treatment modalities.

Main Methods:

• A comprehensive literature search was conducted across multiple databases including CENTRAL, MEDLINE, EMBASE, LILACS, mRCT, ClinicalTrials.gov, and WHO ICTRP up to January 2013.
• Included studies were randomized controlled trials (RCTs) and quasi-RCTs involving patients treated with anti-VEGF agents for NVG.
• Two independent reviewers assessed search results, with discrepancies resolved by a third author. No meta-analysis was performed due to the absence of eligible trials.

Main Results:

• No randomized controlled trials (RCTs) met the inclusion criteria for this review.
• Two identified RCTs were excluded due to heterogeneity and uncontrolled adjunct treatments among participants.
• Consequently, no assessment of risk of bias or meta-analysis could be undertaken.

Conclusions:

• The current evidence base is inadequate to assess the effectiveness of anti-VEGF treatments in lowering IOP for NVG.
• Well-designed RCTs are required to evaluate the long-term benefits and risks (at least six months) of anti-VEGF agents in NVG.
• Future trials should consider co-interventions like PRP, glaucoma surgery, or cataract surgery, potentially using stratification or subgroup analysis to clarify the additional benefit of anti-VEGF agents.