Combined Pars Plana Vitrectomy and Pars Plana Baerveldt Tube Placement in Eyes With Neovascular Glaucoma

Kolomeyer, Anton M.; Seery, Christopher; Emami-Naeini, Parisa; Zarbin, Marco A.; Fechtner, Robert D.; Bhagat, Neelakshi

doi:10.1097/iae.0000000000000235

Cited by 36 publications

(27 citation statements)

References 37 publications

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“…We excluded cases where AIT is contraindicated, notably active neovascular glaucoma. This could bias the results toward AIT by excluding the most complex cases of glaucoma where IOP reduction with AIT (but not BGI) [21] might not be possible.…”

Section: Discussionmentioning

confidence: 99%

Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

Kostanyan

Shazly

Kaplowitz

et al. 2017

Graefes Arch Clin Exp Ophthalmol

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1 AbstractPurpose: To apply propensity score matching to compare Baerveldt glaucoma drainage implants (BGI) to trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to BGI which is traditionally reserved for more severe glaucoma.Methods: BGI and AIT patients with at least one year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients with neovascular glaucoma, with prior glaucoma surgery or without a close match were excluded.Results: Of 353 patients, 30 AIT patients were matched to 29 BGI patients. Baseline characteristics including, IOP, the number of glaucoma medications, type of glaucoma , the degree of VF loss and GI were not significantly different between AIT and BGI. BGI had a preoperative IOP of 21.6±6.3 mmHg compared to 21.5±7.4 for AIT on 2.8±1.1 medications and 2.5±2.3, respectively. At 30 months, the mean IOP was 15.0±3.9 mmHg for AIT versus 15.0±5.7 mmHg for BGI (p>0.05), while the number of drops was 1.5±1.3 for AIT (change: p=0.001) versus 2.4±1.2 for BGI (change: p=0.17; AIT vs BGI: 0.007). Success, defined as IOP<21 mmHg, <20% reduction and no reoperation, was achieved at 1 year in 56% of AIT versus 55% of BGI (p>0.05) and 50% versus 52% at 2.5 years. Conclusions:A propensity score matched comparison of AIT and BGI demonstrated a similar IOP reduction through one year. AIT required fewer medications.2

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Section: Discussionmentioning

confidence: 99%

Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

Kostanyan

Shazly

Kaplowitz

et al. 2017

Graefes Arch Clin Exp Ophthalmol

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“…Our results were similar to the results of Kolomeyer et al . [ 30 ] They performed combined PPV and Baerveldt tube insertion procedure in eyes with NVG. Their results showed that logMAR visual acuities at 18-, 24-, 36-, and 48-month follow-up time points were significantly better than preoperative vision ( P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Ranibizumab Plus Combined Surgery for Treatment of Neovascular Glaucoma with Vitreous Hemorrhage

Yang

et al. 2015

Chinese Medical Journal

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Background:Neovascular glaucoma (NVG) is a refractory glaucoma. The management of NVG is very difficult, and it is more difficult when combined with vitreous hemorrhage. The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage.Methods:A total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study. The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years. The mean intraocular pressure (IOP) was 46.38 ± 5.75 mmHg (1 mmHg = 0.133 kPa) while being treated with the maximum medical therapy. The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution (logMAR BCVA) was 2.62 ± 0.43. All the patients underwent intravitreal injection of 0.5 mg (0.05 ml) ranibizumab combined with pars plana vitrectomy (PPV), pars plana lensectomy (PPL) with a preserved anterior capsule, panretinal photocoagulation (PRP), and trabeculectomy (intravitreal ranibizumab [IVR] + PPV + PPL + PRP + trabeculectomy). The IOP and logMAR BCVA were the main outcome measures in this study.Results:The follow-up period was 12 months. The mean postoperative IOPs were 26.38 ± 3.75 mmHg, 21.36 ± 3.32 mmHg, 18.57 ± 3.21 mmHg, and 16.68 ± 2.96 mmHg, respectively at 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy. At the last follow-up, the mean IOP was significantly lower than the preoperative one (t = 6.612, P = 0.001). At 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy, the mean logMAR BCVA were 1.30 ± 0.36, 1.29 ± 0.37, 1.29 ± 0.39, and 1.26 ± 0.29, respectively. At the last follow-up, the mean logMAR BCVA was significantly improved, and the difference was statistically significant compared with preoperative one (t = 6.133, P = 0.002). The logMAR BCVA improved in 22 eyes (84.62%), and remained stable in 4 eyes (15.38%). The neovascularization in the iris and the angle regressed significantly in all patients 7 days after ranibizumab injection. No serious complications occurred during 12 months of the study.Conclusions:IVR + PPV + PPL + PRP + trabeculectomy can control IOP well and improve BCVA without severe complication for NVG patients with vitreous hemorrhage.

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“…A significant IOP decrease was achieved with the procedure while visual acuity remained unchanged. However, it is important to note that 38 % experienced a decrease in vision [89] However, prospective and comparative studies with longer follow-up are still needed.…”

Section: Introductionmentioning

confidence: 99%

Neovascular glaucoma: a review

et al. 2016

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Neovascular glaucoma (NVG) is a secondary glaucoma generally associated with poor visual prognosis. The development of new vessels over the iris and the iridocorneal angle can obstruct aqueous humor outflow and lead to increased intraocular pressure. The underlying pathogenesis in most cases is posterior segment ischemia, which is most commonly secondary to proliferative diabetic retinopathy or central vein retinal occlusion. The neovascularization process in the eye is driven by the events that alter the homeostatic balance between pro-angiogenic factors, such as the vascular endothelial growth factor and anti-angiogenic factors, such as the pigment-epithelium-derived factor. Early diagnosis of this condition through slit lamp examination of the iris, iridocorneal angle and retina can help to avoid the development of goniosynechia and obstruction of aqueous humor outflow, with consequent intraocular pressure elevation. Historically, NVG treatment was focused on reducing the posterior segment ischemic process that caused the formation of new vessels, through panretinal photocoagulation. Recently, several studies have investigated the application of intravitreal anti-VEGF therapies in NVG. If clinical treatment with the use of hypotensive topical drops is not sufficient, laser and/or surgical procedures are required for intraocular pressure control.

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Combined Pars Plana Vitrectomy and Pars Plana Baerveldt Tube Placement in Eyes With Neovascular Glaucoma

Cited by 36 publications

References 37 publications

Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

Ranibizumab Plus Combined Surgery for Treatment of Neovascular Glaucoma with Vitreous Hemorrhage

Neovascular glaucoma: a review

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