Ghost cell glaucoma after intravitreous injection of ranibizumab in proliferative diabetic retinopathy

Abstract

BACKGROUND: Intravitreous injection of anti-vascular endothelial growth factor agents has been widely used as an adjunctive method to vitrectomy in eyes with vitreous hemorrhage due to proliferative diabetic retinopathy (PDR). Here we reported a series of patients with PDR who developed ghost cell glaucoma after intravitreous injection and analyzed the potential factors that might be related to the development of ghost cell glaucoma. METHODS: Retrospective case series study. A total of a consecutive 71 eyes of PDR patients who received vitrectomy after intravitreous injection of ranibizumab (IVR) from January 2015 to January 2017 were enrolled in the study.Intraocular pressure (IOP) was recorded before and after intravitreous injection. Medical records of patients were recorded and investigated. The onset and treatment of ghost-cell glaucoma were recorded. RESULTS: There were 8 out of 71 eyes of the PDR patients developed ghost cell glaucoma after they received IVR. The interval between detection of elevation of IOP and intravitreous injection ranged from 0 to 2 days. There were 2 eyes had IOP greater than 30mmHg at the first IOP measurement at 30 minutes after IVR and remained elevated thereafter. The mean maximum IOP was 46.5±8.0 mmHg. There were 5 patients required medicine and 3 patients required additional paracentesis to control IOP. All patients gained normal IOP after vitrectomy and did not require medicine for lowering IOP ever since. The binary backward stepwise logistic regression model showed that the presence of ghost cell glaucoma was associated with tractional retinal detachment (RR= 4.60 [2.02~8.48], p= 0.004) and fibromembrane involving disk (RR=-3.57 [-7.59~-0.92], p=0.03) (AIC= 39.23，AUC=0.88). CONCLUSION: The ghost cell glaucoma can occur after IVR among PDR patients who are required vitrectomy. Attention on postoperative IOP should be paid to patients with PDR undergoing vitrectomy who receive a preoperative intravitreous injection of anti-VEGF agents, especially in patients with severe PDR.