The influence of etiology on surgical outcomes in neovascular glaucoma

Abstract

Background The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD). Methods This was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision. Results One hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation. Conclusions In our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.

Risk factors associated with Ahmed valve implant dysfunction in patients with neovascular glaucoma during the first postoperative year

“…Another clinical characteristic that we report in this study, which is not commonly reported, is the level of glycosylated hemoglobin, which we found in our patients, a median of 8.37% (7.18 -9.70), which reflects poor systemic control. This is reflected in the causes of neovascular glaucoma since while in the literature the three most frequent causes (diabetic retinopathy, central retinal vein occlusion, and ischemic eye syndrome) are reported in percentages that vary between 33% (23)to 61.7% (24), our results show that in 92% of cases the most common cause in the Mexican population is diabetic retinopathy. With these data, we can infer that the Mexican population presents in more advanced stages of the disease, with worse metabolic and systemic control.…”

Changes in the Prevalence of Neovascular Glaucoma in Individuals Over Sixty-Five Years of Age During the Covid-19 Pandemic

“…BCVA values were converted to a logarithm of minimum resolution angle (LogMAR) system for statistical analysis. Non-Snellen visual acuities were converted to finger counting (2.0), hand gestures (2.3), light perception (2.6), and no light perception (3.0) (8). The numbers of patients presenting before and after lockdown were evaluated in terms of age, gender, the eye(s) involved, etiology, IOP, BCVA, the medical or surgical treatment applied, and lens status.…”

Management of Neovascular Glaucoma

“…The etiology of NVG also affects prognosis. For instance, an underlying retinal vein occlusion has been shown to have a worse visual prognosis after tube shunt surgery compared with other causes of neovascularization 104 . Unfortunately, it is not common for NVG eyes to progress to total blindness and discomfort despite medical and surgical therapy.…”

“…For instance, an underlying retinal vein occlusion has been shown to have a worse visual prognosis after tube shunt surgery compared with other causes of neovascularization. 104 Unfortunately, it is not common for NVG eyes to progress to total blindness and discomfort despite medical and surgical therapy. In cases of profound vision loss particularly associated with pain in eyes that are unlikely to benefit from other intervention, retrobulbar injection of alcohol or enucleation may be recommended to increase patient comfort.…”