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H. Ozaki, J. Y. Huang, M. Ohsato, H. Kondo, K. Oshima, E. Uchio; Retinectomy as Treatment for Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3967.
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Medical therapy and various types of surgical modalities have been established for the treatment of neovascular glaucoma (NVG). Vitrectomy has been proved to be effective, but not sufficient in lowering the intraocular pressure by itself. We have performed an alternative method, retinectomy, at the time of vitrectomy for those patients with advanced stage of NVG.
Retinectomy was performed for 30 eyes with NVG in Fukuoka University from April 1998 to October 2004. Twenty six eyes had proliferative diabetic retinopathy (PDR), and 4 eyes had central retinal vein occlusion (CRVO). The average age was 53.4 years old and the average follow-up period was 32.3 months. Pars plana vitrectomy was carried out with a 120 degrees retinectomy performed in the peripheral retina. SF6 gas was injected as a tamponade. We report the outcome of the treatment of retinectomy.
The average intraocular pressure was 37.0 ± 12.0 mmHg at the time of first surgery and was decreased to 13.1 ± 5.1 mmHg at the final visit. Uncontrollable high intraocular pressure occurred in 14 eyes after the first retinectomy. Additional retinectomy was performed in 9 eyes and trabeculectomy in 5 eyes. In the PDR group, visual acuity improved in 8 eyes (31%), remained unchanged in 11 eyes (42%), and worsened in 7 eyes (27%). Final visual acuity was 20/32 or better in 6 eyes (23%) and 5 eyes (19%) resulted in no light perception. Visual outcome was poor in cases with CRVO. However, the intraocular pressure was well controlled.
Retinectomy with vitrectomy provides a reduction of intraocular pressure in cases with NVG. Our long-term results demonstrated its efficacy. Furthermore, retinectomy may overcome conjunctival complications due to repeated surgical interventions such as trabeculectomy or vitrectomy and it may also decrease the incidence of both intraoperative bleeding and postoperative hyphema associated with NVG.
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