Serial Aqueous VEGF Analysis for Predicting Anti-VEGF Treatment Outcomes in Neovascular Glaucoma from Diabetic Retinopathy: a prospective analysis

Abstract This study evaluated the effectiveness of intravitreal bevacizumab (IVB) in neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR). It assessed outcomes of three bi-weekly IVB injections and analyzed the correlation between serial aqueous VEGF levels and clinical parameters to predict treatment efficacy. A prospective study was conducted on 17 NVG patients due to PDR. Each received three bi-weekly IVB injections. Aqueous VEGF levels, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured before and after treatment. Follow-up continued for three years, with additional injections given as needed. After three injections, VEGF levels significantly dropped from 4681.46 pg/mL to 104.55 pg/mL. BCVA improved from 1.27 to 0.91 (LogMAR), and IOP decreased from 32.71 mmHg to 25.29 mmHg. Higher initial VEGF levels were linked to worse BCVA, elevated IOP, and more frequent injections. Patients needing six or more injections had significantly worse baseline VEGF, BCVA, and IOP. Three bi-weekly IVB injections effectively reduced VEGF levels, improved IOP, and enhanced BCVA. Serial VEGF monitoring helps predict outcomes, as higher initial VEGF levels indicate more severe disease and increased treatment needs. Aqueous VEGF serves as a valuable biomarker for NVG management.