Outcomes of neovascular glaucoma in eyes presenting with moderate to good visual potential

Rani, Padmaja Kumari; Sen, Pranay K.; Sahoo, Niroj Kumar; Senthil, Sirisha; Chakurkar, Renuka; Anup, Manju; Behera, Umesh Chandra; Sivaprasad, Sobha; Das, Taraprasad

doi:10.1007/s10792-021-01789-y

Cited by 10 publications

(10 citation statements)

References 22 publications

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“…With adequate posterior segment treatment to decrease the neovascular drive, the outcomes of trabeculectomy and glaucoma drainage devices offer similar success in NVG. [ 27 28 29 ] In a study by Rani et al ,[ 10 ] eyes with NVG and VA better than 20/200 at presentation reported similar success rates in the outcomes of trabeculectomy in the Indian eyes compared to the glaucoma drainage device in a UK cohort.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 8 9 ] Over 50% of the eyes with NVG need surgery for IOP control. [ 10 ] The success rates of trabeculectomy with mitomycin-C in the eyes with NVG secondary to PDR vary from 62.6 to 81.2% at 1 year and reduce to 51.3 at 5 years. [ 8 11 ] Trabeculectomy with mitomycin-C, use of intravitreal anti-vascular endothelial growth factor (VEGF) agents, and aggressive panretinal photocoagulation (PRP) has improved the success rates of trabeculectomy.…”

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confidence: 99%

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Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure

Senthil

Chary²,

Ali³

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To evaluate the outcomes of trabeculectomy in the eyes with neovascular glaucoma (NVG), caused by proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO), and ocular ischemic syndrome (OIS). Methods: A retrospective review of NVG eyes that underwent trabeculectomy between 1991 and 2019. Complete success was defined as intraocular pressure (IOP) between 6 and 21 mmHg without antiglaucoma medications (AGM). The risk factors were analyzed by Cox's proportional hazard model. Results: The study included 100 eyes of 100 subjects with a mean age of 58 ± 9.8 years and a median follow-up of 1.27 years (interquartile range: 0.63, 2.27). The cause of NVG was PDR in 59 eyes (59%), CRVO in 25 eyes (25%), and OIS in 16 eyes (16%). Trabeculectomy with mitomycin-C was performed in 88 eyes and trabeculectomy in 12 eyes. The cumulative complete success probability of trabeculectomy in PDR was 50% (95% confidence interval [CI]: 38, 65) at 1 year, 8% (1, 46) at 3–5 years. In OIS, it was 64% (43, 96) from 1 to 5 years. In CRVO, it was 75% (59, 94) at 1 year, 45% (23, 86) from 2 to 5 years. The PDR was associated with a higher risk of surgical failure compared to OIS ( P = 0.04) and CRVO ( P = 0.004). Other significant risk factors were increasing age ( P = 0.02), persistent neovascularization of iris (NVI) ( P = 0.03), higher number of anti-vascular endothelial growth factor (VEGF) injections prior to trabeculectomy ( P = 0.02), and delay in performing trabeculectomy ( P = 0.02). Conclusion: Compared to CRVO and OIS, the eyes with NVG secondary to PDR had poor success with trabeculectomy. Older age, persistent NVI, need for a higher number of anti-VEGF injections, and delayed surgery were associated with a higher risk for trabeculectomy failure.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure

Senthil

Chary²,

Ali³

et al. 2021

Indian Journal of Ophthalmology

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“…Retinal ocular manifestations are related to vasoocclusive phenomena with a compensatory vasoproliferative response that can be complicated by neovascular glaucoma (NVG) and exudative retinal detachment, outcomes that occurred in the patient's LE. The approach can be done with laser photocoagulation in the ischemic retinal areas and symptomatic medications for NGV, with such therapeutic measures being performed, but, however, the prognosis still remained reserved [4,11,15].…”

Section: Discussionmentioning

confidence: 99%

Neovascular Glaucoma Secondary to Bloch-Sulzberger Syndrome Documented by Retinography and Wide Field Angiography

Miguel

et al. 2022

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Aims: To describe a Neovascular Glaucoma Secondary to Bloch-Sulzberger Syndrome. Presentation of Case: A.B.F. female, 23 years old, claimed significant pain sensation and hyperemia in the left eye (LE) for 45 days, without triggering factors. She came to the consultation with a previous diagnosis of Bloch-Sulzberger Syndrome with pigmented lesions in the lower limbs since childhood, being followed up by dermatology since then. Discussion: The diagnosis of IP (Incontinentia Pigmenti) is complex because it mimics other dermatoses. The impairment in other systems, such as the ophthalmic system, with the possibility of loss of vision and functional disability is a reality. The natural history of retinal lesions is not fully understood. Vascular changes seem to start in the first weeks of life and progress after birth for weeks or months, and may stabilize at any stage, leaving numerous sequelae. Conclusions: Incontinentia pigmenti is difficult to diagnose and, at each evolutionary stage, presents many differential diagnoses. Eye injuries can lead to blindness as a consequence of ischemic events that can start soon after birth.

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“…Non-English speakers, increasing age, multiple comorbidities and lack of health insurance cover, longer distance travelled for clinical appointment and failure to attend other non-eye-related appointments have all been reported as factors associated with lost to follow-up. [10][11][12] Although the proportions of patients with no records increased over time, some patients especially those included from 2019 will have less follow-up and the COVID-19 pandemic could have affected the longer follow-up. However, the mortality rate of 13% is high given that the mean age of this cohort was 59 years.…”

Section: Discussionmentioning

confidence: 99%

“…Very few patients with PDR present with neovascular glaucoma. 11 Over the last 40 years, PRP has prevented severe visual loss in most patients who present early with PDR. However, there are recent reports that show the proportion lost to follow-up is high in patients with PDR and cost of treatment may be a factor.…”

Section: Introductionmentioning

confidence: 99%

Visual acuity outcome of stable proliferative diabetic retinopathy following initial complete panretinal photocoagulation

Thottarath

Faes

et al. 2022

BMJ Open Ophth

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BackgroundRecent clinical trials on proliferative diabetic retinopathy (PDR) show that presenting visual acuity can be stabilised with panretinal photocoagulation (PRP) within 2 years despite the need for supplementary PRP or anti-vascular endothelial growth factor therapy for concomitant diabetic macular oedema (DMO). It is unclear whether similar results can be obtained in daily clinical practice. Here, we query the probability of vision loss in patients with treatment-naïve PDR who have attained stability after PRP and its predictors.MethodsRetrospective cohort study at a tertiary eye centre between 01 January 2015 and 31 December 2019, wherein 2336 eyes met study criteria with first record of stable PRP-treated PDR in at least one eye. Kaplan-Meier and Cox proportional hazards modelling were used to report the probability of vision loss of at least five Early Treatment Diabetic Retinopathy Study (ETDRS) letters.ResultsThe probability of losing at least five ETDRS letters was 50% at 3.32 (95% CI, 2.94 to 3.78) years after achieving first stability post PRP in treatment-naïve PDR. The mean decrease at this event was 14.2 (SD 13.0) ETDRS letters irrespective of the presence of DMO. The strongest risk factor for vision loss was a history of DMO at baseline (HR 1.62 (95% CI, 1.34 to 1.95), p<0.001).DiscussionOne in two patients with stable treated PDR lose a line of vision by 3.5 years. This resulted in 15% of patients losing their eligibility to drive. Notably, 13% of the cohort died during the follow-up period.

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Outcomes of neovascular glaucoma in eyes presenting with moderate to good visual potential

Cited by 10 publications

References 22 publications

Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure

Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure

Neovascular Glaucoma Secondary to Bloch-Sulzberger Syndrome Documented by Retinography and Wide Field Angiography

Visual acuity outcome of stable proliferative diabetic retinopathy following initial complete panretinal photocoagulation

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