Anti-vascular endothelial growth factor for neovascular glaucoma

Area of Science:

• Ophthalmology
• Vascular Biology
• Glaucoma Research

Background:

• Neovascular glaucoma (NVG) is a severe secondary glaucoma characterized by abnormal blood vessel growth, impeding aqueous humor drainage and elevating intraocular pressure (IOP).
• Anti-vascular endothelial growth factor (anti-VEGF) medications target key mediators of neovascularization, offering a potential therapeutic strategy for NVG.
• Previous studies suggest anti-VEGF agents may be effective in managing IOP in NVG, necessitating further investigation.

Purpose of the Study:

• To evaluate the efficacy of intraocular anti-VEGF medications, used alone or in conjunction with conventional therapies, compared to treatments without anti-VEGF agents for NVG.
• To synthesize evidence from randomized controlled trials (RCTs) assessing the impact of anti-VEGF medications on IOP control and other relevant outcomes in NVG.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, Embase, PubMed, LILACS) up to March 2019, with no date or language restrictions.
• Included studies were randomized controlled trials (RCTs) involving patients with NVG treated with anti-VEGF medications.
• Data extraction and risk of bias assessment were performed independently by two reviewers, with discrepancies resolved through discussion.

Main Results:

• Four RCTs involving 263 participants were included. The trials exhibited an unclear risk of bias due to limited information.
• Results regarding IOP reduction were inconsistent across studies. One trial showed no significant difference in mean IOP at one month or one year, while another indicated a significant IOP reduction with anti-VEGF treatment.
• The certainty of evidence for IOP control was low, attributed to study design limitations and result heterogeneity. Post-operative complications were reported in both anti-VEGF and control groups. Key outcomes like visual acuity improvement and regression of new vessels were not reported.

Conclusions:

• Current evidence on the long-term effectiveness of anti-VEGF medications as an adjunct therapy for lowering IOP in NVG remains uncertain.
• Further research is essential to elucidate the long-term effects of anti-VEGF medications compared to or in addition to conventional treatments for NVG.
• The limited and inconsistent data underscore the need for high-quality RCTs to establish definitive treatment guidelines for NVG.