Combined anti-VEGF approach in neovascular glaucoma: clinical outcomes of intracameral and intravitreal bevacizumab administration.

BACKGROUND: To evaluate short-term clinical outcomes of combined intracameral and intravitreal bevacizumab administration in patients with neovascular glaucoma (NVG), with emphasis on intraocular pressure (IOP), best-corrected visual acuity (BCVA), and regression of anterior segment neovascularization. METHODS: This retrospective study included 90 eyes of 81 patients with NVG who received simultaneous intracameral and intravitreal bevacizumab injections between January 2020 and January 2025. BCVA, IOP, and rubeosis iridis were assessed at baseline and at 1 week, 1 month, and 3 months post-treatment. Additional interventions, including panretinal photocoagulation (PRP), repeat anti-VEGF injections, and glaucoma surgeries, were documented. RESULTS: The mean patient age was 65.47 ± 10.06 years, and 69.2% were male. Diabetic retinopathy (66.7%) and central retinal vein occlusion (26.7%) were the most common underlying etiologies. Median BCVA demonstrated modest improvement, with statistically significant gains at 1 and 3 months compared with baseline (p < 0.01). Mean IOP decreased significantly from 32.9 ± 12.1 mmHg at baseline to 21.4 ± 10.1 mmHg at 3 months (p < 0.001). Regression of rubeosis iridis was observed in 71.5% of eyes by month 3. PRP was performed in 66.7% of cases, while trabeculectomy or cyclocryotherapy was required in 23.3% of eyes. Hyphema occurred in 3.3% of patients, with no other serious complications. CONCLUSIONS: Combined intracameral and intravitreal bevacizumab appears to be a safe and effective short-term strategy for NVG management, providing significant IOP reduction and regression of anterior segment neovascularization. Although visual improvement was limited, this dual-route anti-VEGF approach may serve as an effective bridge therapy facilitating subsequent definitive retinal or glaucoma interventions, particularly in advanced cases with corneal edema.