Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

Strzalkowski, Piotr; Strzalkowska, Alicja; Göbel, Werner; Loewen, Nils A.; Hillenkamp, Jost

doi:10.12688/f1000research.26879.2

Cited by 7 publications

(5 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fong et al [ 37 ] compared DCPC alone and DCPC with IVB for NVG patients and reported that DCPC alone was effective in lowering IOP in NVG patients, and the addition of IVB did not statistically enhance treatment outcomes. On the other hand, Strzalkowski et al performed CPC combined with IVB, PRP, and vitrectomy for 77 eyes with NVG, and achieved effective IOP reduction, visual acuity preservation, and the reduction of antiglaucoma medications, with phthisis bulbi as the only late complication in 3.9% of eyes [ 40 ]. We also used IVB in our study but for a different purpose; IVB was employed to improve outcomes of TLE–MMC in our series.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy in Japanese Patients without the Use of Glaucoma Drainage Devices

Takeuchi,

Kanda,

Harimoto

et al. 2024

JCM

View full text Add to dashboard Cite

Purpose: The purpose of this study is to investigate outcomes of visual acuity (VA) and intraocular pressure (IOP) in proliferative diabetic retinopathy (PDR)-associated neovascular glaucoma (NVG) in Japanese patients treated with surgical therapies without the use of glaucoma drainage devices. Methods: A retrospective analysis of medical records was conducted for 31 consecutive PDR-associated NVG patients who underwent surgical treatments in our institution between 2013 and 2022. Patient demographics, clinical characteristics, VA, and IOP were recorded at the first and last visits, and surgical procedures, including 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 a prior intravitreal bevacizumab (IVB) injection, were reviewed. Results: Of the thirty-one PDR patients with NVG, two patients received PPV–PRCP or DCPC alone (6.5%), respectively, three patients received TLE–MMC alone (9.7%), two patients received TLE–MMC after IVB (6.5%), six patients received PPV–PRCP and TLE–MMC (19.4%), seven patients received PPV–PRCP and TLE–MMC after IVB (22.6%), five patients received PPV–PRCP and DCPC and TLE–MMC (16.1%), and four patients received PPV–PRCP and DCPC and TLE–MMC after IVB (12.9%). The VA of two patients (6.5%) deteriorated to no light perception. In all patients, the mean logMAR VA was 1.28 ± 1.05 at the first visit and remained at 1.26 ± 1.08 at the last visit, with no significant change; the mean IOP was 33.0 ± 15.2 mmHg at the initial visit and decreased significantly to 14.0 ± 7.4 mmHg at the last visit. The number of eyes with IOP ≥ 21 decreased from twenty-eight (90.3%) to three (9.7%). Although IOP in patients with IOP > 30 mmHg at the initial visit reduced to a level comparable to that of patients with IOP ≤ 30 mmHg, the IOP > 30 mmHg group received IVB more frequently and had significantly higher logMAR VA at the last visit compared to the IOP ≤ 30 mmHg group. Hypotony (<6 mmHg) was observed in four eyes (12.9%). Conclusions: In PDR patients with NVG, various combinations of PPV–PRCP, DCPC, and TLE–MMC after adjunctive IVB without the use of glaucoma drainage devices lowered IOP sufficiently; for these patients, neovascular regression was observed, with no further deterioration of VA. However, surgical procedures should be performed for PDR patients with NVG before visual impairment occurs. On the other hand, approximately less than 15% of patients developed blindness or low IOP.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy in Japanese Patients without the Use of Glaucoma Drainage Devices

Takeuchi,

Kanda,

Harimoto

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…Despite adequate PPV and endolaser PRP, these patients may require intravitreal anti-VEGF injections in the future due to nonresolving retinal/iris NV. [151][152][153] Management of glaucoma can be performed either with trabeculectomy or glaucoma drainage device (GDD) insertion. In general, trabeculectomy has a high failure rate in eyes with NVG.…”

Section: Neovascular Glaucomamentioning

confidence: 99%

Update on Retinal Vein Occlusion

Romanò

Lamanna

Gabrielle

et al. 2023

Asia-Pacific Journal of Ophthalmology

View full text Add to dashboard Cite

Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assessment of retinal ischemia at baseline and during follow-up examinations remains crucial. New imaging techniques have shed light on the pathophysiology of the disease and laser treatment, once the only therapeutic option, is now only one of the possible approaches with antivascular endothelial growth factors and steroid injections being preferred in most cases. Nowadays long-term outcomes are better than those achievable 20 years ago and yet, many new therapeutic options are under development, including new intravitreal drugs and gene therapy. Despite this, some cases still develop sight-threatening complications deserving a more aggressive (sometimes surgical) approach. The purpose of this comprehensive review is to reappraise some old but still valid concepts and to integrate them with new research and clinical data. The work will provide an overview of the disease's pathophysiology, natural history, and clinical features along with a detailed discussion on the advantages of multimodal imaging and of the different treatment strategies with the aim of providing retina specialists with the most updated knowledge in the field.

show abstract

“…Eine rezente Studie aus Würzburg zeigte verhältnismäßig günstige Ergebnisse für eine einmalige Operation mit einer Kombination aus einer transskleralen Diodenlaser-Zyklophotokoagulation (20 Herde), einer Pars-plana-Vitrektomie mit nahezu konfluenter Endolaserkoagulation von den Gefäßbögen bis zur Ora serrata und einer intravitrealen Bevacizumab-Eingabe [54]. Bei phaken Augen wurde zusätzlich eine Katarakt-Operation durchgeführt.…”

Section: Merkeunclassified