Abstract
Purpose :
Neovascular glaucoma (NVG) is a debilitating disease secondary to retinal ischemia. This study aims to examine NVG cases at Parkland Memorial Hospital and assess patient characteristics that may have impacted the types of management employed and ultimately the visual acuity (VA) and intraocular pressure (IOP) outcomes. In doing so, we hope to gain helpful insight for the management of future NVG cases.
Methods :
This was a retrospective chart review of neovascular glaucoma cases at Parkland Memorial Hospital with at least 6 months of follow up. Outcome metrics included number of glaucoma medications utilized, IOP, VA, and number of surgeries performed.
Results :
We found that proliferative diabetic retinopathy (PDR) was by far the most common cause of NVG in our patient population (84.62%), followed by retinal vein occlusion (RVO) (12.09%).
75% of patients with a presenting VA of 20/400 or better underwent primary tube shunt while 50% of patients with presenting VA worse than 20/400 underwent primary cyclophotocoagulation (CPC). For patients who underwent a single surgery, there was no significant difference in IOP outcomes at 1 month (p=0.92), 6 months (p=0.51), or 1 year (p=0.70) after surgery, or at the final follow up (p=0.13) between CPC vs. tube shunt. There was also no significant difference in number of surgeries required to control IOP between primary CPC vs. tube shunt cases (p=0.31).
Patients with presenting VA of 20/400 or better had significantly better VA at 1 month, 6 months, and 1 year post diagnosis, and at the final follow up visit than those with presenting VA worse than 20/400 (p<0.05).
Patients with a presenting systolic blood pressure less than 130 mm Hg had a lower IOP at 1 year post diagnosis than those with a higher systolic pressure (p=0.02), but otherwise there was no difference in IOP between the two groups at any of the other measured timepoints (p>0.05).
Conclusions :
Similar to the general population, we observed that PDR and RVO are the two leading causes of NVG. Our practice pattern is consistent with commonly implemented patterns in that the majority of eyes 20/400 or better visual acuity underwent primary tube shunt while eyes with poorer presenting visual acuity underwent primary CPC. Presenting visual acuity appears to provide insight into a patient’s long term visual prognosis. Blood pressure control at presentation also seems to be a modifiable risk factor for progression of NVG.
This is a 2021 ARVO Annual Meeting abstract.