Efficacy and safety of Ex-PRESS® mini shunt surgery versus trabeculectomy for neovascular glaucoma: a retrospective comparative study

Kawabata, Kazuyuki; Shobayashi, Kohei; Iwao, Keiichiro; Takahashi, Eri; Tanihara, Hidenobu; Inoue, Toshihiro

doi:10.1186/s12886-019-1083-4

Cited by 18 publications

(14 citation statements)

References 24 publications

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“…At present, the treatment of neovascular glaucoma includes the following: the treatment of primary disease, the elimination of the retinal ischemic state (panretinal photocoagulation), and the drug or surgical control of IOP. The main surgical methods include filtration surgery, aqueous humor drainage implantation, and ciliary body destruction surgery [ 16 ]. Because the neovascularized fibrous membrane can cause extensive peripheral anterior synechia and destroy the anatomic structure of the angle of the anterior chamber, it is difficult to cut the iris root, easily injure the ciliary body, and cause serious bleeding, so anterior chamber hemorrhage is a common complication after operation [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage

Shi

Dong

Liang

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. To evaluate the clinical efficacy of the combined application of 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction in the treatment of neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) combined with vitreous hemorrhage (VH). Methods. Eighty-three patients (91 eyes) with PDR diagnosed as NVG phase III complicated with VH from June 2018 to May 2020 were selected as the study subjects. The subjects were randomly divided into 3 groups: group A was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation; group B was given 23G minimally invasive vitrectomy combined with phacoemulsification cataract extraction; and group C was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation and phacoemulsification cataract extraction. The uncorrected visual acuity (UCVA), intraocular pressure (IOP), and iris neovascularization (INV) scores were recorded and compared among the 3 groups before and after operation, and then the postoperative pain relief and complications were observed. Results. Through observation, there was no significant difference in the UCVA, IOP, and INV scores in the 3 groups before operation. After the operation, the UCVA, IOP, and INV scores of the 3 groups were significantly lower than those before operation. After operation, the UCVA of the 3 groups increased first and then decreased, and it improved most significantly in the 3rd month after operation and decreased in the 4th month after operation. There were significant differences in UCVA among the 3 groups at each time point after operation. From the 1st day to the 6th month after operation, the IOP of the 3 groups showed an upward trend, and there was no significant difference among the 3 groups in IOP at each time point after operation. At the 1st, 3rd, and 6th months after operation, the INV score of group A and group B was higher than that of group C. There was no significant difference in the INV score between group A and group B. The incidence of complications was not significantly different among the 3 groups. Conclusion. 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction can effectively improve the UCVA, IOP, and INV scores of NVG secondary to PDR with VH, and the combined application of the 3 methods has better security.

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Section: Discussionmentioning

confidence: 99%

23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage

Shi

Dong

Liang

et al. 2022

Computational and Mathematical Methods in Medicine

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“…found that,Ex-PRESS mini shunt surgery was less effective than trabeculectomy, but is a safer surgical aproach for NVG. Hyphema and bleb leaks were less common in patients treated with Ex-PRESS shunt device [3].…”

Section: Shen Et Al Reported That the Success Results Of Ahmed Glaucoma Valve Implantation And Trabeculectomymentioning

confidence: 87%

“…There are few publications reporting that Ex-PRESS glaucoma drainage device implantation provides better postoperative performance and is more reliable than trabeculectomy alone in neovascular glaucoma. The usage of adjuvant theraphy such as bevacizumab also affects the success of surgeries [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of neovascular glaucoma with Ex-PRESS glaucoma shunt

Fikret¹,

Uçgun²

2021

Preprint

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Purpose To compare the efficacy and safety profile of deep sclerectomy combined with Ex-PRESS shunt versus Ex-PRESS shunt surgery in eyes with neovascular glaucoma. Methods Twenty eyes with neovascular glaucoma secondery to proliferative diabetic retinopathy were included in our study. Panretinal photocoagulation and intravitreal bevacizumab injection were applied to these eyes. Despite full antiglaucomatous treatment and iris, angle neovascularization regression whose intraocular pressures were 21mm Hg and above were taken to surgery. Patients were randomly divided into two groups. Group A (10 patients) underwent deep sclerectomy combined with insertion of Ex-PRESS drainage device, group B (10 patients) underwent only Ex-PRESS glaucoma filtration surgery. Primary outcome measures were the intraocular pressure (IOP) and the number of antiglaucomatous medications at the first year follow-up visit. Results There was no difference in IOP between the groups at the first 2 month postoperatively (p>0.05). In the first 2 months, there was no need for antiglaucomatous medication in either group. In the third month, an antiglaucomatous drug was administered to 2 patients in group A and to 4 patients in group B. IOP values were lower in group A than group B at the third and sixth months (p<0.05). At the end of the first year, ≤18 mm Hg IOP rate was found 80% in group A and 60 in group B without medication. Conclusion Ex-PRESS shunt surgey demonstrated to be an effective treatment in eyes with neovascular glaucoma at the first year follow-up period. Ex-PRESS drainage device implantation with deep sclerectomy increased surgical success.

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“…In these cases, the injection of alcohol into the retrobulbar space should be considered as a therapeutical method. Sometimes, evisceration or enucleation are the only reasonable decisions [2,9,13,51,[74][75][76][77][78][79][80][81][82][83][84][85].…”

Section: Some Interesting Datamentioning

confidence: 99%

A review of neovascular glaucoma. Etiopathogenesis and treatment.

Dumbrăveanu

Cușnir

Bobescu

2021

rjo

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Neovascular glaucoma (NVG) is a type of secondary glaucoma, refractory to treatment, often incurable, with very poor visual prognosis. It is characterized by the appearance of new vessels over the iris and iridocorneal angle and frequently associates the presence of a fibrovascular membrane which limits the aqueous humor outflow from the anterior chamber. The most common causes of NVG are: central retinal vein occlusion, proliferative diabetic retinopathy, and ocular ischemic syndrome. Once the gonioscopy developed as a part of clinical examination, it became possible to visualize the new vessels of the anterior segment of the eye in early stages and to understand the mechanisms of increased intraocular pressure (IOP), including narrowing and closing of the iridocorneal angle. Also, the modern imaging techniques, such as optical coherence tomography angiography and fluorescein angiography became indispensable for the clinician. Thus, an early diagnosis, followed by starting an appropriate therapy: panretinal photocoagulation or administration of anti-VEGF drugs, with or without hypotensive ocular therapy, allows the preservation of visual functions for patient’s better quality of life. However, one or more surgeries will often be required, especially in the advanced stages of the disease, which do not respond to drug therapy. Managing the NVG we should aim to: 1) reduce ocular ischemia and treat its underlying cause, 2) reduce elevated IOP, once installed and 3) control the inflammatory process. Anyway, the best treatment is prevention, so we must be very attentive at patients with risk factors for developing the NVG. Abbreviations: NVG = neovascular glaucoma, ICA = iridocorneal angle, IOP = intraocular pressure, TM = trabecular meshwork, AH = aqueous humor, AC = anterior chamber, PRP = panretinal photocoagulation, VEGF = vascular endothelial growing factor, Anti-VEGF = anti- vascular endothelial growing factor, PAS = peripheral anterior synechiae, CRVO = central retinal vein occlusion, PDR = proliferative diabetic retinopathy, DR = diabetic retinopathy, OIS = ocular ischemic syndrome, CRAO = central retinal artery occlusion, ROP = retinopathy of prematurity, FEVR = familial exudative vitreoretinopathy, PVR = proliferative vitreoretinopathy, MMPs = matrix metalloproteinases, VEGFR = vascular endothelial growing factor receptor, PDGF = platelet-derived growth factor, PIGF = placental growth factor, NRP = neuropilins, HIF = hypoxia-inducible factor, SDF1 = stromal cell-derived factor 1, DDL4 = delta like ligand 4, NICD = Notch intracellular domain, TIMMPs = tissue inhibitors of matrix metalloproteinases, ANGPT = angiopoietin, Tie 2 = tyrosine-protein kinase receptor for angiopoietins, IGF-1 = insulin-like growth factor 1, RPE = retinal pigment epithelium, IL = interleukin, TNF = tumor necrosis factor, bFGF = basic fibroblast growth factor, TGF = transforming growth factor, HGF = hepatocyte growth factor, TNFR 2 = tumor necrosis factor receptor 2, OIR = oxygen induced retinopathy, NVI =...

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Efficacy and safety of Ex-PRESS® mini shunt surgery versus trabeculectomy for neovascular glaucoma: a retrospective comparative study

Cited by 18 publications

References 24 publications

23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage

23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage

Surgical treatment of neovascular glaucoma with Ex-PRESS glaucoma shunt

A review of neovascular glaucoma. Etiopathogenesis and treatment.

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