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Tahsin Choudhury, Sara T. Ali, Peter J. Maris, Lama A. Al-Aswad; Comparison of Visual Acuity and Intraocular Pressure Outcomes of Surgical Versus Medical Management of Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5934.
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To compare best corrected visual acuity (BCVA) and intraocular pressure (IOP) outcomes of neovascular glaucoma (NVG) managed by surgical versus medical treatments of glaucoma in addition to the required retinal treatments.
In a retrospective comparative study, the medical records of 40 eyes of 40 patients diagnosed with NVG at one institution during an 11-year period were reviewed. The included eyes were divided into two groups. The medical group (n=10) consisted of management solely with IOP-lowering eye drops, the surgical group (n=30) with Ahmed Valve Implant or trabeculectomy with Mitomycin-C. LogMar BCVA and IOP were analyzed with Fisher’s exact test over a 12-month period.
Average follow-up was 12±4 months. There was no statistically significant difference between the age, gender, baseline number of drops or NVG etiology between the groups. The medical group had an increased incidence of Pan-Retinal Photocoagulation (PRP) (70% vs. 20%) and intra-vitreal Bevacizumab injections (30% vs. 13.3%). 14 eyes in the surgical group required IOP-lowering drops despite surgery. The mean BCVA improvement at 12 months in the medical and surgical group was 0.02 (SD ±0.66) and 0.12 (SD ±0.81), respectively; the difference between the groups was not statistically significant (P=0.74). Respectively, the medical and surgical group had a mean baseline IOP of 28.78 (SD ±10.85) and 34.16 (SD ±8.37) with a 12-month IOP of 21.4 (SD ±8.25) and 14.26 (SD ±5.04), demonstrating mean IOP reduction of 8.11 (SD ±2.75) and 19.90 (SD ±1.87) with statistical significance (P=0.0035; CI:[4.13-19.45]).
NVG is a refractory glaucoma that requires surgical and medical treatment modalities. No significant differences in BCVA improvement were found between the two groups at 12 months. However, there was a statistically significant greater IOP reduction at 12 months in the surgical group. Our short-term results indicate that surgical treatment of NVG appears more effective in lowering IOP and requires less adjunctive therapies. Additional longer-term studies should be conducted.
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