Assessing the role of ranibizumab in improving the outcome of glaucoma filtering surgery and neovascular glaucoma.

INTRODUCTION: Ranibizumab was the first anti-vascular endothelial growth factor (VEGF) agent approved for the treatment of neovascular age-related macular degeneration. The use of ranibizumab and other anti-VEGF medications in recent years has revolutionized the treatment of several sight-threatening retinal disorders. Emerging evidence has demonstrated that anti-VEGF treatment can offer advantages in the management of other ocular conditions where VEGFs play a key role: ocular scarring following glaucoma filtering surgery and neovascular glaucoma (NVG). Areas covered: We critically review available evidence on the use of ranibizumab as a wound healing modulator in glaucoma filtering surgery and as an adjunct in the management of NVG. Expert opinion: Based on the available evidence and the authors' clinical experience, ranibizumab is a valuable adjunct in the management of NVG. In glaucoma filtering surgery, however, the role of ranibizumab is less clear and does not provide a significant advantage over mitomycin C. Drawbacks for its use in glaucoma include cost, its off-label use, uncertainty and limited evidence on the various routes of administration, the optimal dosing schemes and its toxicity profile. Future advances in ranibizumab delivery systems allowing less frequent dosing may change this treatment paradigm.