Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

Abstract

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

“…All 77 patients (45 male, 32 female, mean 73.6±12.2 years, range 29–91 years) completed a one-year follow-up and were included in the retrospective analysis ( Figure 1 ). Conditions that lead to NVG included CRVO 41.6% (32/77), PDR 35.1% (27/77), CRAO 19.5% (15/77), and ocular ischemic syndrome 3.9% (3/77) 37 ( Table 1 ).…”

“…Open Science Framework: Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series. https://doi.org/10.17605/OSF.IO/QTCGV 37 .…”

Update on Retinal Vein Occlusion

“…Due to VH, red blood cells from the posterior chamber can also block the trabecular meshwork resulting in ghost cell glaucoma, for which PPV becomes an important treatment strategy. Despite adequate PPV and endolaser PRP, these patients may require intravitreal anti-VEGF injections in the future due to nonresolving retinal/iris NV 151–153…”

Sekundärglaukome im Rahmen retinaler Erkrankungen

“…Bemerkenswert ist, dass in der Gruppe der Diodenlaser-Zyklophotokoagulation keine Phthisis bulbi auftrat, während 2 Patienten in der Gruppe mit dem Ahmed-Drainage-Implantat eine Phthisis entwickelten. Eine rezente Studie aus Würzburg zeigte günstige Ergebnisse für eine einmalige Operation mit einer Kombination aus einer transskleralen Diodenlaser-Zyklophotokoagulation (20 Herde), einer Pars-plana-Vitrektomie mit nahezu konfluenter Endolaserkoagulation von den Gefäßbogen bis zur Ora serrata und einer intravitrealen Bevacizumab-Eingabe 40 . Bei phaken Augen wurde zusätzlich eine Kataraktoperation durchgeführt.…”

“…It is worth noting that no phthisis bulbi occurred in the diode laser cyclophotocoagulation group, whereas two patients in the Ahmed drainage implant group developed this condition. A recent study from Würzburg showed favorable results for a single operation with a combination of transscleral diode laser cyclophotocoagulation (20 foci), pars plana vitrectomy with near-confluent endolaser coagulation from the vascular arches to the ora serrata, and intravitreal bevacizumab administration 40 . In phakic eyes, cataract surgery was also performed.…”