Purchase this article with an account.
Khalid Al Rubaie; Neovascular glaucoma (NVG) progress and impact of therapeutic intervention at King Khaled Eye Specialist Hospital, Saudi Arabia.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5718.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Successful outcomes of intervention in neovascular glaucoma (NVG) have been limited. We present outcomes of therapeutic interventions for NVG between 2002 and 2012 at a tertiary eye hospital in Saudi Arabia.
In this ophthalmic charts review, we examined all cases with NVG diagnosed by vitreo-retinal and glaucoma units of King Khaled Eye Specialist Hospital during the study period. Baseline demographics, visual acuity and intraocular pressure (IOP) were compared to that at last follow up. The data related to therapeutic intervention, the clinical course of treated and fellow eyes and reasons for poor vision were collected.
We studied 597 eyes with NVG. The mean IOP at presentation was 32 mmHg. At presentation, 335 eyes (56.1%) were treated with panretinal photocoagulation (PRP) (pattern or conventional single spot laser); 67 eyes (11.2%) were treated with intravitreal bevacizumab injection only, 9 eyes(1.5%) with cryotherapy, 5 eyes (1%) cases with pars planavitrectomy and 33 eyes (5.5%) with combination of above treatment. In 459 (77%) NVG eyes, IOP was controlled with topical glaucoma medications, cyclophotocoagulation (n=28;5%), trabeculectomy [n=5(1%) with or without mitomycin], glaucoma shunts (n=6; 1%) and combination of surgeries 61(10%). Visual acuity on last follow up was 20/20 to 20/40 in 19 (3%) eyes, 20/50 to 20/200 in 67 (11%) eyes, <20/200 to 20/400 in 267 (45%) eyes, and <20/400 in 225 (38%) eyes. In19 (3%) eyes vision could not be noted due to soft/enucleated eye. In 45(8%) eyes vision improved, 305 (51%) eyes maintained VA and in 229 (38%) eyes vision got worse. The IOP at last follow-up declined to <22 mmHg in 369 (62%) eyes, remained 23 to 30 mmHg in 69 (12%) eyes and was more than 31 mmHg in 102 (17%) eyes. In 26 (3.7%)eyes, ocular hypotony was noted. In 38 (5.8%) patients, IOP information on last follow up was missing. The causes of poor vision included retinal ischemia (n=75,13%), optic nerve head cupping (n=104, 17%), retinal detachment (n= 42, 7%) and other causes (n=17,3%).
NVG is a serious ocular ischemic complication. Prompt therapy targeting ischemia including intravitreal injection of bevacizumab and a combination of medical and surgical therapy maintained or improved VA and controlled IOP <22 mmHg in more than half of our patients.
This PDF is available to Subscribers Only