Survival in patients with neovascular glaucoma following tube shunt implant or cyclodestructive procedures

Abstract

Purpose : To determine the survival of patients with neovascular glaucoma (NVG) after tube shunt implant or cyclodestructive procedure, and to assess whether clinical factors are predictive of survival.

Methods : A retrospective chart review was performed of patients with NVG who underwent tube shunt implant and/or cyclodestructive procedures (cyclophotocoagulation and cyclocryotherapy) between January 2002 and December 2019 at the Minneapolis Veterans Affairs Medical Center (VAMC). Patient survival was compared to the age and gender matched Minnesota population. Univariate and regression analyses were used to evaluate the correlation of specific clinical parameters with survival.

Results : A total of 39 patients and 41 eyes were included. Tube shunt alone was implanted in 30 (73.2%) eyes, cyclodestruction alone was performed in 9 eyes (22%), and 2 eyes (4.9%) underwent both procedures. The mean (median) age at first operation was 70.2 (70) years. The most common etiology of NVG was diabetic retinopathy (DR) in 20 eyes (48.8%), followed by central retinal vein occlusion in 14 eyes (34.1%). Diagnoses of cardiovascular diseases and diabetes were found in 38 patients (97.4%) and 33 patients (84.6%), respectively. At post-operative 5-year follow-up, survival rate of the NVG patients was 56% compared to 80% in controls. There was no difference in survival between patients with NVG secondary to DR and those from other etiologies, although patients with NVG caused by DR had their first procedure at a younger age (p = 0.036). Preoperative visual acuity, maximum intraocular pressure (IOP), creatinine, HbA1c, and postoperative IOP at 6 months were not associated with survival.

Conclusions : In the Minneapolis VAMC population, NVG patients had a lower survival rate than the matched Minnesota population. Most patients had vasculopathic risk factors. The etiology of NVG was not associated with survival. Ophthalmologists should consider the shorter survival when planning surgery for NVG patients and recommend a multi-disciplinary approach to optimize their care.

This is a 2021 ARVO Annual Meeting abstract.

 

Survival of patients with NVG by post-operative year compared with age and gender-matched Minnesota (MN) population during the 5-year follow-up period.

 

Survival of patients with NVG caused by diabetic retinopathy compared with other etiologies during the 5-year follow-up period (p = 0.431).