Use of Intravitreal Aflibercept Injection for Neovascular Glaucoma

The two arms of this study will compare current common practice (initial intravitreal anti-VEGF (vascular endothelial growth factor) to study treatment (VEGF) injection only) for 52 weeks.

This single center study will consist of 20 patients with NVG. Patients will be randomized to:

• Group A: A single injection of 2mg (0.05ml) intravitreal aflibercept injection at baseline followed by standard of care laser with observation for a total of 52 weeks.

or

• Group B: 2mg (0.05ml) intravitreal aflibercept injection at baseline followed by two additional injections at 4 weeks and 8 weeks, then every 8 weeks for a total of 52 weeks.

Clinical assessment will include pain assessment (Universal Pain Scale), best corrected visual acuity (ETDRS), ophthalmic examination, anterior segment assessment including number of clock-hours of NVI/NVA, gonioscopy, anterior segment photography, visual field test (Humphrey SITA- Standard 24-2), optic nerve OCT (Zeiss Cirrus Optic Disc Cube 200x200), macular OCT (Cube scan 512 x 128 and 5 Line Raster), fluorescein angiography (initial iris phase followed by standard retinal angiography), and concurrent medical/ocular medications. Qualitative assessment of neovascularization will be made by the investigator based on comparison to baseline angiography.

Inclusion criteria

• Patients with a diagnosis of neovascular glaucoma (Stage I-II)
• Individuals who are ages 21-90 years old; male or female of any race
• Presence of neovascularization of the iris and/or angle
• At least 90 degrees of "unzipped" anterior chamber angle as noted by gonioscopy. (a "zipped angle is the term used for a drainage angle that is slowly closing due to scar tissue from the neovascularization process)
• Visual acuity of light perception or better in the study eye
• Willing and able to comply with clinic visits and study-related procedures
• Provide signed informed consent

Exclusion criteria

• Use of intravitreal anti-VEGF agents in the study eye in the past 3 months.
• Full PRP in the study eye
• Prior vitrectomy in the study eye
• Prior trabeculectomy or other filtration surgery in the study eye
• Active ocular or periocular infection in the study eye
• Ocular conditions (Cataract or vitreous hemorrhage) that might require surgery in next 12 months
• Allergy to fluorescein dye
• Any past use of systemic anti-VEGF medication
• Myocardial infarction within 6 months prior to study enrollment
• Stroke within 6 months prior to study enrollment
• Pregnant or breast-feeding women
• Sexually active men or women of childbearing potential who are unwilling to practice adequate contraception during the study