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Carolina Meneses Galicia, José Ramón Juberías Sánchez, Sara Sánchez Tabernero, Núria Artells de Jorge, Sara Crespo Millas, Lucía Manzanas Leal, Maria Isabel López Gálvez; Ahmed valve implantation and laser cyclophotocoagulation as elected treatment for diabetic neovascular glaucoma: a retrospective study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2067.
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© ARVO (1962-2015); The Authors (2016-present)
Neovascular glaucoma (NVG) is a potential complication of proliferative Diabetic Retinopathy (DR) that often leads to blindness and/or intractable pain. We perform a retrospective, observational clinical study to analyze the efficacy and safety of different treatment options for the management of diabetic NVG.
We included patients diagnosed with diabetic NVG from 2006 to 2016 at Hospital Clínico Universitario de Valladolid (Spain). They were diagnosed, followed and treated by the same experienced glaucoma surgeon. Extracted data included clinical characteristics of the patients, glycated haemoglobin (HbA1c) levels, visual acuity (VA), intraocular pressure (IOP) and ocular treatment type (Ahmed valve implantation, laser cyclophotocoagulation [CPC] and topical antihypertensive medications), in the preoperative and postoperative period (follow-up data obtained at 1, 3, 6, 12 and 24 months). Treatment success regarding the visual function was defined as maintenance or improvement of VA (patients with a baseline VA of no light perception were excluded) and treatment success regarding IOP control was defined as IOP of 21 mmHg or less with or without medical treatment.
30 eyes from 23 patients were followed for a mean of 4.48 years (SD=2.82). The IOP lowering intervention groups were: Ahmed valve implantation (11 eyes), laser CPC (6 eyes), both (4 eyes) and topical medical treatment (8 eyes). IOP success was achieved in 100% eyes with Ahmed valve implantation and/or laser CPC and in 44.4% of eyes with no surgical procedure, statistical significance (p= 0.002). Most eyes with Ahmed valve (with or without the addition of CPC) maintained or improved the VA (100% and 63.6%, respectively). A minority of the eyes with CPC or no surgical procedure maintained or improved the VA (33.3% and 25%, respectively). Differences among these 4 groups were statistically significant (p=0.028). Severe hypotony (IOP less than 6 mmHg) was the only adverse eye event observed in one patient (after laser CPC).
Ahmed valve implantation and CPC are safe and effective treatment options in terms of lowering IOP and maintaining VA for diabetic NVG. Topical medical treatment by itself is not the best option for IOP control and preventing subsequent vision loss in most patients with diabetic NVG.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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