Abstract
Purpose :
Neovascular glaucoma (NVG), a severe complication of proliferative diabetic retinopathy (PDR), can lead to irreversible vision loss. Surgical intervention is often necessary to control intraocular pressure (IOP) and preserve visual acuity (VA) in NVG patients. In this study, we investigated VA and IOP in PDR-associated NVG patients treated with surgical therapies in a clinical setting.
Methods :
A retrospective analysis of medical records was conducted for 35 consecutive PDR-associated NVG patients who underwent surgical treatments in our institution between 2013 and 2022. Patient demographics, clinical characteristics, surgical procedures of pars plana vitrectomy with extensive panretinal and ciliary photocoagulation (PPV-PRCP), diode laser trans-scleral cyclophotocoagulation (DCPC), and trabeculectomy with mitomycin C (TLE-MMC) with or without prior intravitreal bevacizumab injection (IVB), and VA and IOP at the first and last visits were reviewed.
Results :
The mean patient age was 62.9 ± 12.1 years, with a male-to-female ratio of 26:9. The mean follow-up period was 34.0±34.5 months. Two patients (5.7%) each underwent PPV-PRCP or DCPC alone, 3 patients (8.6%) had TLE-MMC alone, 2 patients (5.7%) had TLE-MMC after IVB, 7 patients (20.0%) had PPV-PRCP and TLE-MMC, 8 patients (22.9%) had PPV-PRCP and TLE-MMC after IVB, 5 patients (14.3%) had PPV-PRCP and DCPC and TLE-MMC, and 4 patients (11.4%) had PPV-PRCP and DCPC and TLE-MMC after IVB. Mean logMAR VA was 1.25 ± 1.0 at the first visit and 1.25 ± 1.08 at the last visit, with no significant change. However, the number of patients with no light perception increased from 3 to 6. Mean IOP was 31.9 ± 14.8 mmHg at the initial visit and decreased significantly to 13.9 ± 7.0 mmHg at the last visit (< 0.0001). Number of eyes with IOP ≧ 21 decreased from 30 (85.7%) to 3 (8.6%). Hypotony (≦ 5 mmHg) was observed in 4 eyes (11.4%).
Conclusions :
Various surgical techniques can effectively manage NVG associated with PDR. The surgical procedure should be individualized based on the patient's clinical characteristics and disease severity. A combination of surgical approaches may be necessary to achieve optimal IOP control and preserve vision.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.