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Y. Kiuchi, K. Fukui, Y. Saito; Pars Plana Vitrectomy and Panretinal Photocoagulation Combined with Trabeculectomy for Successful Treatment of Neovascular Glaucoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3410.
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Treatment of neovascular glaucoma (NVG) must be focused on the reduction of intraocular pressure (IOP) and prompt application of pan retinal photocoagulation (PRP). A combination of complete PRP from vitreous cavity with trabeculectomy should theoretically be a better method to lower the IOP rapidly in eyes with NVG. The purpose of our study is to assess the efficacy of combining pars plana vitrectomy and PRP with mitomycin C (MMC) assisted trabeculectomy on NVG eyes secondary to diabetic retinopathy.
Twenty–five eyes with NVG associated with diabetic retinopathy had pars plana vitrectomy, followed by PRP and trabeculectomy with MMC. The eyes were divided into two groups: nine eyes with vitreous hemorrhage, fibrovascular membrane and/or retinal detachment were placed in the Proliferation group; and sixteen eyes without vitreous hemorrhage, fibrovascular membrane, or retinal detachment were placed in the PC group. The surgical outcome in the two groups was assessed by Kaplan–Meier survival analysis. The criteria for success were a postoperative intraocular pressure (IOP) ≤21 mmHg and a preservation of light perception.
Kaplan–Meier life–table analysis showed that the overall success rate was 72.0% after 1 year and 61.7% after 2 and 3 years. The surgical outcome was significantly better in the PC group than in the Proliferation group (P = 0.009). In the proliferation group, 4 eyes had preoperative vitreous hemorrhage, 3 eyes had a fibrovascular membrane, and 2 eyes had a retinal detachment. Three of 4 eyes with vitreous hemorrhage achieved good IOP control. On the other hand, the IOP of all eyes with retinal detachment and fibrovascular membrane were not lowered significantly.
Complete PRP combined with trabeculectomy with MMC can effectively reduce the elevated IOP in eyes with NVG. However, this combined treatment is not effective in eyes with proliferative membranes and retinal detachments.
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