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Piotr Strzalkowski, Alicja Strzalkowska, Dorothee Hommes, Andre Rosentreter, Winfried Goebel, Thomas Ach, Jost Hillenkamp; A combined surgical approach to neovascular glaucoma: one-year follow up.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3766.
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© ARVO (1962-2015); The Authors (2016-present)
Neovascular glaucoma (NVG) is a potentially blinding disease and difficult to manage. This retrospective analysis evaluates the safety and efficacy of a comprehensive combined surgical approach to NVG.
Consecutive ongoing interventional case series of 73 eyes of 73 patients with decompensated NVG treated with 23 Gauge pars plana vitrectomy, full-scatter panretinal endolaser, transscleral cyclophotocoagulation (810 nm diode laser, 2W, 2s, 20 spots), intravitreal bevacizumab, and air tamponade. Phakic eyes underwent concomitant cataract surgery. 40 eyes have completed one-year follow-up. At baseline and follow-up visits (1, 3, 6, 12 months) best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), medication score of antiglaucomatous drugs, visual analog pain scale (VAPS, 0-10) were recorded. Blind eyes were excluded. MANOVA test was applied for statistical analysis, significance level p<0.05.
40 eyes of 40 patients (26 male, 14 female, median age 74 years, range 48-89) were included. NVG underlying ocular conditions included proliferative diabetic retinopathy (n=16), retinal vein occlusion (n=15), central retinal artery occlusion (n=7), and ocular ischemic syndrome (n=2). Median BCVA increased slightly between baseline (2.0; range 2.1-0.3) and 12 months follow-up (1.5; range 3.0-0.2) (p<0.001). IOP decreased significantly from baseline (median: 48.5; range: 30-68) to all follow-up visits: 1 month (16.8; 4-36), 3 months (20.8; 4-52), 6 months (14.1; 1-36), and 12 months (14.2; 0-53) (p<0.001). Antiglaucomatous medication score decreased significantly between baseline (4.5; range 0-8) and 12 months follow-up (1.8; range 0-5) (p<0.001). While 14 patients complained of ocular pain at baseline (VAPS: median 6, range 3-9) all patients were without pain at all follow-up visits. Post-operative ocular side effects included intraocular fibrinous reaction (n=30), choroidal detachment (n=7), hyphema (n=7) and corneal erosion (n=5), all of which had completely resolved at first follow-up 1 month postop. 22 eyes did not require any additional surgical treatment during follow-up. 9 eyes underwent one additional cyclodestructive surgery.
This comprehensive single surgery approach significantly lowered IOP, effectively controlled pain, and reduced the need for antiglaucomatous drugs. BCVA remained poor in most eyes. Most eyes did not require further surgical interventions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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