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