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

Li, Xiujuan; Yang, Xiaopeng; Li, Qiuming; Wang, Yuying; Lyu, Xiao-Bei

doi:10.4103/0366-6999.161371

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…e BCDVA LogMAR improved in 8 eyes (66.67%) and remained stable in 2 eyes (16.66%). Our results were similar to the results of Li et al [20] who reported that at 12 months after PPV, pars plana lensectomy (PPL), PRP, and trabeculectomy, the mean LogMAR of BCDVA was 1.26 ± 0.29, and this difference was statistically significant when compared with the mean LogMAR of preoperative BCDVA of 2.62 ± 0.43 (P � 0.002), and the LogMAR of BCDVA improved in 22 eyes (84.62%) and remained stable in 4 eyes (15.38%). However, they used pars plana lensectomy (PPL) for different degree of cataract density with IOL implantation in the sulcus, preoperative intravitreal injection of ranibizumab, and a shorter period of follow-up (1 year), but in our study, we used temporal corneal incision phacoemulsification for all our cases, which had dense cataract with IOL implantation in the capsular bag, preoperative IVB, and a longer follow-up period of 2 years.…”

Section: Discussionsupporting

confidence: 93%

“…Our target IOP was achieved for complete success in 83.33% and 90.9% and for qualified success in 91.66% and 100% at 1 and 2 years, respectively. ese results were better than that reported by Li et al study [20], in which their mean IOP decreased significantly from 46.38 ± 5.75 to 16.68 ± 2.96 mmHg. eir complete success was 65.38% and qualified one was 84.62% at the last follow-up visit; however, their follow-up period was only 12 months.…”

Section: Discussioncontrasting

confidence: 69%

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Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Moharram

Elwan

Nassar

et al. 2020

Journal of Ophthalmology

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Purpose. One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions. Methods. 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study. Results. The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P<0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P<0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period. Conclusions. This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 69%

Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Moharram

Elwan

Nassar

et al. 2020

Journal of Ophthalmology

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“…In our study, we strictly controlled other risk factors for glaucoma, such as CCT and IOP, for which there are no known significant differences [ Table 1 ]. Although CCT and IOP are considered important risk factors for the development of glaucoma,[ 17 18 19 20 21 ] we found in this study that an eye with a worse VF did not necessarily have a thinner cornea and a higher IOP. This led us to take a new understanding of the development of NTG.…”

Section: Discussionmentioning

confidence: 53%

Corneal Biomechanical Parameters and Asymmetric Visual Field Damage in Patients with Untreated Normal Tension Glaucoma

Cai

Pan

et al. 2017

Chinese Medical Journal

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Background:High intraocular pressure (IOP) and low central corneal thickness (CCT) are important validated risk factors for glaucoma, and some studies also have suggested that eyes with more deformable corneas may be in higher risk of the development and worsening of glaucoma. In the present study, we aimed to evaluate the association between corneal biomechanical parameters and asymmetric visual field (VF) damage using a Corvis-ST device in patients with untreated normal tension glaucoma (NTG).Methods:In this observational, cross-sectional study, 44 newly diagnosed NTG patients were enrolled. Of these, 31 had asymmetric VF damage, which was defined as a 5-point difference between the eyes according to the Advanced Glaucoma Intervention Study scoring system. Corneal biomechanical parameters were obtained using a Corvis-ST device, such as time from start until the first and second applanation is reached (time A1 and time A2, respectively), cord length of the first and second applanation (length A1 and length A2, respectively), corneal speed during the first and second applanation (velocity A1 and velocity A2, respectively), time from start until highest concavity is reached (time HC), maximum amplitude at the apex of highest concavity (def ampl HC), distance between the two peaks at highest concavity (peak dist HC), and central concave curvature at its highest concavity (radius HC).Results:Time A1 (7.19 ± 0.28 vs. 7.37 ± 0.41 ms, P = 0.010), length A1 (1.73 [1.70–1.76] vs. 1.78 [1.76–1.79] mm, P = 0.007), length A2 (1.58 [1.46–1.70] vs. 1.84 [1.76–1.92] mm, P < 0.001), peak dist HC (3.53 [3.08–4.00] vs. 4.33 [3.92–4.74] mm, P = 0.010), and radius HC (6.20 ± 0.69 vs. 6.59 ± 1.18 mm, P = 0.032) were significantly lower in the worse eyes than in the better eyes, whereas velocity A1 and def ampl HC were significantly higher (0.156 [0.149–0.163] vs. 0.145 [0.138–0.152] m/s, P = 0.002 and 1.19 ± 0.13 vs. 1.15 ± 0.13 mm, P = 0.005, respectively). There was no significant difference in time A2, velocity A2, and time HC between the two groups. In addition, no difference was observed in IOP, CCT, and axial length. In the univariate and multivariate analyses, some of the Corvis-ST parameters, including time A1 and def ampl HC, were correlated with known risk factors for glaucoma, and there was also a significant positive correlation between def ampl HC and age.Conclusions:There were differences in dynamic corneal response parameters but not IOP or CCT between the paired eyes of NTG patients with asymmetric VF damage. We suggest that the shape of the cornea is more easily altered in the worse eyes of asymmetric NTG patients.

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“…Ranibizumab (Lucentis, Novartis), another anti-VEGF drug, a fragment of a recombinant humanized IgG1 monoclonal antibody that inhibits all isoforms of the human VEGF-A, has been shown to be beneficial as an adjuvant treatment in neovascular glaucoma and rubeosis due to its antiangiogenic properties [ 9 ]. A current study by Li et al reported that ranibizumab plus combined surgery for treatment of NVG with VH was effective [ 23 ]. Based on the previous findings, we hypothesize that intravitreal injection of ranibizumab in eyes with NVG companied with PDVH may induce regression of new vessels and reduce the possibility of repeated bleeding, thus shortening the reabsorption time, lowering higher IOP, and reducing the need for surgery.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy

Shen

Chen

Wang

et al. 2016

Journal of Ophthalmology

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Purpose. To determine the efficacy of intravitreal ranibizumab injection as adjuvant therapy in the treatment of neovascular glaucoma (NVG) accompanied by postvitrectomy diabetic vitreous hemorrhage (PDVH). Methods. Eighteen NVG patients (18 eyes) accompanied by PDVH were enrolled in this prospective, monocenter, 12-month, interventional case series. The consecutive 18 patients with an IOP ≥ 25 mmHg despite being treated with the maximum medical therapy were treated with intravitreal ranibizumab injections. Vitreous surgery or/with Ahmed valve implantation were indicated if no clinical improvement in vitreous haemorrhage and uncontrolled IOP was shown. Results. Ten patients got clear vitreous and controlled IOP only with 2.7 ± 1.8 injections of ranibizumab without additional surgery. Vitrectomy or/with Ahmed valve implantation was administered in the other 8 eyes due to uncontrolled VH and IOP. At follow-up month 12, all the 18 eyes gained clear vitreous. At month 12 BCVA improved significantly compared to baseline. The baseline and follow-up at month 12 IOP/medication usage were 36.7 ± 8.1 mmHg on 3.4 ± 0.7 medications and 16.2 ± 4.9 mmHg on 0.67 ± 0.77 medications, respectively. Conclusions. The findings suggest that intravitreal ranibizumab injection as adjuvant therapy for treatment of NVG accompanied by PDVH may be safe and potentially effective. This clinical trial is registered with NCT02647515.

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

Cited by 9 publications

References 27 publications

Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Corneal Biomechanical Parameters and Asymmetric Visual Field Damage in Patients with Untreated Normal Tension Glaucoma

Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy

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