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Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma—results from a prospective interventional case series

  • Medical Ophthalmology
  • Published:
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Abstract

Background

To evaluate the capability of adjuvant intraocular ranibizumab (Lucentis®) injections in the treatment of rubeosis and intraocular pressure in patients with rubeosis and neovascular glaucoma.

Methods

Ten eyes with rubeosis (R) and ten eyes with neovascular glaucoma (NVG) received Lucentis® injections (ranibizumab 0.5 mg/0.05 ml) in this prospective, monocenter, 12-months, interventional case series. The primary efficacy outcome measure was the change of degree of iris rubeosis as documented by iris fluorescein angiography measured after 12 months. Secondary outcomes were intraocular pressure (IOP), best-corrected visual acuity (BCVA, logMAR), numbers of additional interventions or antiglaucoma medications administered after injection, the gonioscopic status of the anterior chamber angle, and central retinal thickness.

Results

In the R group, 3.6 injections and in the NVG group 2.3 injections of Lucentis® were administered. Additional treatments were photocoagulation (n = 19), cyclodestructive procedures (n = 9), cryopexy (n = 3), and vitrectomy (n = 1). The mean stage of rubeosis was 3.4 ± 0.7 in the R group and 3.6 ± 0.8 in the NVG group at baseline. At month 12, the rubeosis was almost resolved in the R group (0.1 ± 0.3, p < 0.001), and decreased significantly in the NVG group (0.7 ± 1.1, p < 0.001). In the NVG subgroup, mean IOP was 41.4 ± 13.4 mmHg at baseline, which decreased rapidly (18.2 ± 12.3, day-14, p = 0.005) and stabilized during the follow-up (15.6 ± 2.0 mmHg, p < 0.05). BCVA improved significantly in both groups (p < 0.05, at month 12).

Conclusions

Injection of 0.5 mg ranibizumab appears to be beneficial as an adjuvant treatment in neovascular glaucoma and rubeosis due to its anti-angiogenic properties and its ability to prevent establishment or progression of anterior chamber angle obstruction. Conventional therapeutic procedures addressing the retinal ischemia are still required in a stage-wise treatment approach.

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Conflict of interest

No conflicting relationship exists for any author.

Financial support

Novartis Pharma GmbH. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Julia Lüke, Khaled Nassar, Matthias Lüke & Salvatore Grisanti

Authors
  1. Julia Lüke
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  2. Khaled Nassar
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  3. Matthias Lüke
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  4. Salvatore Grisanti
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Corresponding author

Correspondence to Julia Lüke.

Additional information

Matthias Lüke and Salvatore Grisanti contributed equally to the work, and should be considered equivalent senior authors.

Clinical Trials registration number: NCT01370135

Presented on DOG 2011 (SA57-356)

The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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Lüke, J., Nassar, K., Lüke, M. et al. Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma—results from a prospective interventional case series. Graefes Arch Clin Exp Ophthalmol 251, 2403–2413 (2013). https://doi.org/10.1007/s00417-013-2428-y

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  • DOI: https://doi.org/10.1007/s00417-013-2428-y

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