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Christopher W. Seery, Christopher Seery, Parisa Emami-Naeimi, Anton Kolomeyer, Marco Zarbin, Robert Fetchner, Neelakshi Bhagat; Characteristics and Outcomes of Eyes with Neovascular Glaucoma (NVG) that Underwent Combined Pars Plana Vitrectomy (PPV) and Baerveldt Glaucoma Shunt Procedure. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5932.
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To describe characteristics and outcomes of eyes with NVG that underwent combined PPV and Baerveldt glaucoma shunt procedure from 2005-2010.
Retrospective series. Changes in IOP and glaucoma medications were compared by a paired sample t-test. A Kaplan-Meier survival curve was constructed to evaluate IOP control as a function of time.
Eighty-nine eyes undergoing a combined procedure for NVG were identified. Mean patient age was 69.0 years (range:37-90); 48 (53.9%) were male. The mean follow-up time was 19.9 months (range: 2-66 months). The cause of NVG in 70.8 % (63) of eyes was diabetes, 22.5% (20) was central retinal vein occlusion and other diagnoses in the remaining 6 eyes. 55 eyes (61.8%) had received pan retinal photocoagulation laser, anti-VEGF intravitreal injection or both preoperatively. 9 eyes (10.1%) had undergone a prior glaucoma procedure. Mean pre-operative IOP was 36.82 mm Hg. The mean number of glaucoma drops preoperatively was 2.92. Mean IOP post-operatively was 15.76 mmHg; mean preoperative IOP and number of glaucoma medications were significantly (p<0.004) reduced by the combined procedure. 61 (68.5%) eyes encountered a hypertensive phase (IOP>21 mmHg) within a week post-operatively; all were started on IOP lowering agents and IOP normalized in 51 eyes within 3 weeks. VA of 55 (61.8%) eyes improved or remained unchanged. eyes (86.5%)underwent stent removal at a mean duration of 4.7 weeks from surgery. 4 (4.5%) eyes underwent subsequent valve revisions. Post-operative complications noted were retinal detachment in 4 (4.5%) eyes, serous choroidals in 12 (13.5 %) eyes (8 had concurrent hypotony), peripheral hemorrhagic choroidals in 2 (2.2%) eyes, 20 (22.5%) eyes with hypotony (IOP < 6 mm Hg) and endophthalmitis in 1 (1.1%) eye. Hypotony was noted in 20 eyes at a mean duration of 3.6 weeks; spontaneous resolution in 15 eyes within 2 weeks. Small gauge vitrectomy was performed in 45 (50.6%) of 89 eyes.
Combined PPV and Baerveldt glaucoma shunt may be a useful procedure in reducing IOP and number of glaucoma medications in eyes with NVG along with stabilizing VA in majority of these eyes.
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