Abstract
Purpose :
In acute NVG, implanting an aqueous shunt into eyes with active anterior segment neovascularization (NV) increases bleeding related complications. Prompt anti-VEGF rapidly regresses NV but is ineffective at lowering IOP when the angle is already synechially closed. CPC has historically been reserved for eyes with poor visual potential. The purpose of this case series is to describe a single surgeon’s experience utilizing prompt CPC with prior or concurrent anti-VEGF and subsequent aqueous shunt as needed in NVG eyes with synechial angle closure, regardless of visual potential.
Methods :
A retrospective chart review was performed for NVG patients with uncontrolled IOP, active anterior segment NV, a synechially closed angle, no contraindications to prompt anti-VEGF, CPC within 3 days of presentation, and at least 6 months of follow-up.
Results :
Seven patients (3 male, 4 female, all African American) with mean age 63.9 years were included. Underlying etiologies were PDR (N=3), CRVO (N=3), and chronic RD (N=1). All patients received prompt intravitreal anti-VEGF on the day of acute presentation or within 3 days at the time of CPC. Patients received ongoing anti-VEGF injections and PRP at the discretion of the retina service. Five patients did not require subsequent aqueous shunts through a mean follow-up of 14.8 months; most recent visual acuities ranged from 20/50 to LP, and IOPs ranged from 4-20mmHg on 0-3 IOP-lowering medications. Two patients who required subsequent tubes (1 Ahmed 5 weeks later, 1 Baerveldt-350 11 weeks later) had resolution of active anterior segment NV by the time of surgery, and phaco could be performed to facilitate sulcus tube placement. At most recent follow-up (26 and 7 months), visual acuities were 20/40 and 20/150 with normal IOP. No eyes developed uncontrolled anterior segment inflammation, macular edema, or phthisis.
Conclusions :
Prompt primary CPC within 3 days, with prior or concurrent anti-VEGF, is an effective strategy to immediately lower IOP in acute NVG eyes with active anterior segment NV and synechially closed angles, regardless of visual potential. If IOP becomes uncontrolled later, an aqueous shunt can be implanted in a controlled setting after active anterior segment NV has regressed. Further research is needed to compare outcomes of prompt CPC vs aqueous shunt in acute NVG eyes with completely synechially closed angles.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.