Intraoperative findings of posterior vitreous detachment and proliferative membranes in neovascular glaucoma associated with proliferative diabetic retinopathy

Abstract

Purpose : To investigate the appropriate surgical procedure of Baerveldt implantation (BGI) for neovascular glaucoma (NVG), we compared intraoperative findings of posterior vitreous detachment (PVD) and proliferative membranes during vitrectomy in proliferative diabetic retinopathy (PDR) cases with or without NVG.

Methods : The present retrospective study included data from 17 eyes of patients (mean age 55.0 ± 9.2 years) who underwent BGI combined with vitrectomy for NVG and data from 165 eyes of patients (mean age 55.2 ± 11.7 years) who underwent vitrectomy for PDR at Yamagata University Hospital between 2008 and 2017. All patients were treated using 25-gauge pars plana vitrectomy that was performed by the same surgeon (K.N.). During surgery, intraoperative findings regarding the presence or absence of PVD and proliferative membrane were recorded. In 14 recent NVG cases and 53 recent PDR cases, intraoperative findings were also observed using intraoperative OCT (iOCT) RESCAN.

Results : PVD observed was significantly lower in the NVG group (no eyes; 0%) than the PDR group (39 eyes, 23.6%; Fisher’s exact test, P < 0.05). Furthermore, proliferative membranes observed were significantly lower in the NVG group (3 eyes, 16.7%) than the PDR group (88 eyes, 53.3%; Fisher’s exact test, P < 0.05). Finally, in PVD (−) eyes in the NVG and PDR groups, partial PVD (+) was observed using iOCT in both groups; however, partial PVD (+) was significantly lower in the NVG group (4 eyes, 28.6%) than in the PDR group (41 eyes, 97.6%; P < 0.05).

Conclusions : PVD and proliferative membranes were observed significantly less frequently in the NVG group than in the PDR group. Furthermore, iOCT revealed partial PVD was significantly less frequent in the NVG group than in the PDR group. When performing BGI combined with vitrectomy in the eyes of patients with NVG, it is considered necessary to perform vitrectomy taking patients being PVD (−) into consideration.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.