Intravitreal ranibizumab as an adjunct to conventional surgery for neovascular glaucoma: a retrospective observational study of efficacy and clinical characteristics of surgical failure cases.

Background: Intractable neovascular glaucoma (NVG), secondary to retinal ischemia, responds poorly to traditional surgery due to postoperative neovascularization and scarring. Intravitreal ranibizumab(IVR) swiftly alleviates neovascularization to enable subsequent treatment, yet its long-term efficacy remains unclear. Aim: This study sought to evaluate the ranibizumab-surgery combination therapy in NVG and describe clinical characteristics of surgical failure cases. Methods: This retrospective propensity score matching (PSM) cohort study enrolled 62 patients (62 eyes) with NVG between August 2022 and August 2024. Using 1:1 nearest-neighbor PSM, 31 eyes received preoperative IVR plus conventional surgery (study group), while 31 underwent surgery alone (control group). Over 12 months of follow-up, the primary endpoint was the 12-month surgical success rate; secondary outcomes included IOP, BCVA, postoperative NVI status, and complications. IOP and BCVA were analyzed using linear mixed-effects models, and clinical characteristics of the failure cases were described descriptively. Results: After PSM, baseline characteristics were generally comparable between groups, with residual imbalances noted for glaucoma stage and angle status. The study group showed significantly lower IOP at all postoperative visits (P < 0.05). The 12-month surgical success rate was numerically higher in the study group (93.5% vs. 77.4%). Secondary outcomes, including BCVA improvement and favorable NVI-free status, were more favorable in the study group, while the difference in overall complications did not reach statistical significance. Among the 9 failure cases, the majority had poor baseline BCVA, diabetes mellitus, and advanced glaucoma stage. Conclusion: In this retrospective matched cohort, adjunctive IVR was associated with more favorable IOP control and NVI-free status, whereas the difference in the 12-month surgical success rate, although numerically higher, did not reach statistical significance. Given the exploratory nature of this single-center study, larger prospective studies are warranted to confirm these findings. Significance and innovation: This retrospective matched cohort study suggests that perioperative ranibizumab may be associated with more favorable IOP control and NVI-free status, although the 12-month surgical success rate did not reach statistical significance. These findings are exploratory and require confirmation in larger prospective studies.