Long-Term Results of Pars Plana Vitrectomy Combined With Filtering Surgery for Neovascular Glaucoma

Abstract

* BACKGROUND AND OBJECTIVE: To analyze the effectiveness of vitrectomy combined with filtering surgery for neovascular glaucoma. * PATIENTS AND METHODS: Twenty-one eyes with neovascular glaucoma underwent pars plana vitrectomy combined with filtering surgery between January 1995 and December 2003. Thirteen eyes (10 cases) had neovascular glaucoma secondary to proliferative diabetic retinopathy and 8 eyes (8 cases) had neovascular glaucoma secondary to central retinal vein occlusion. The initial intraocular pressures ranged from 21 to 70 mm Hg with full medication. All cases were observed for more than 12 months after the last surgery and the ophthalmic records were retrospectively reviewed. * RESULTS: During the follow-up period, 19 eyes (90.5%) had intraocular pressures of less than 21 mm Hg with or without antiglaucoma eye drops, whereas 18 eyes (85.7%) had a stable or improved visual acuity. * CONCLUSION: Vitrectomy combined with filtering surgery is considered to be an effective treatment for neovascular glaucoma to maintain the visual function for a long period. [Ophthalmic Surg Lasers Imaging 2005;35:211-216.]

Pars plana vitrectomy and panretinal photocoagulation combined with trabeculectomy for successful treatment of neovascular glaucoma

“…Bartz-Schmidt et al [1], who reduced the IOP by cyclophotocoagulation, reported 10 of 32 eyes (31.3%) lost light perception. On the other hand, the pars plana filtration method used by Kono et al [6] led to a loss of light perception in only two of 21 eyes (9.5%). Their procedure appeared safe, but they did not mention the severity of complications associated with filtration at the pars plana.…”

“…Their success rate of maintaining an IOP ≤21 mmHg with preservation of light perception was 56% after 1 year. Kono et al [6] reported on the effect of pars plana vitrectomy combined with filtering surgery for NVG. Their filtering surgery consisted of making microholes at the pars plana by irradiating with the endolaser after resecting the sclera.…”

“…The management of NVG is particularly difficult in eyes in which adequate PRP is not possible due to vitreous hemorrhage and/or coexistent retinal detachment. However, it is possible to resolve these problems by pars plana vitrectomy, so panretinal laser treatments can be performed [1,6,7]. Moreover, three-port pars plana vitrectomy enables us to apply PRP from the posterior pole to the ora serrata.…”

“…An elevation of the intraocular pressure (IOP) by NVG decreases the ocular perfusion leading to retinal ischemia, and the ischemia induces neovascularization. A prompt reduction of IOP and application of PRP to alleviate the effects of ischemia are important procedures used for the treatment of NVG [1,6,7]. The management of NVG is particularly difficult in eyes in which adequate PRP is not possible due to vitreous hemorrhage and/or coexistent retinal detachment.…”

Current management of diabetic tractional retinal detachments

“…As surgical instrumentation and skills have improved, more complicated cases are being operated on[ 61 ] and the threshold for surgery has decreased. [ 42 43 62 63 64 65 66 ] Advances in vitreoretinal surgery include wide-field viewing systems, multiport illumination systems,[ 67 ] perfluorocarbon liquids, and silicone oil. [ 45 ] The use of silicone oil, as opposed to long-acting gas tamponade, may accelerate visual rehabilitation, maintain tamponade, prevent hypotony,[ 68 ] and decrease the incidence of recurrent bleeding or rubeosis.…”