Outcomes of Valved and Nonvalved Tube Shunts in Neovascular Glaucoma

Shalaby, Wesam Shamseldin; Myers, Jonathan S.; Razeghinejad, Reza; Katz, L. Jay; Pro, Michael J.; Dale, Elena; Fudemberg, Scott J.; Mantravadi, Avinash V.; Shukla, Aakriti Garg

doi:10.1016/j.ogla.2020.09.010

Cited by 15 publications

(13 citation statements)

References 47 publications

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“…This study echoed the findings of other important publications that both valved and non-valved GDDs performed similarly in the context of NVG [ 14 , 24 , 25 ]. Final IOP in both groups.…”

Section: Discussionsupporting

confidence: 89%

“…High rates of failure with conventional trabeculectomy surgery [ 8 – 10 ] have led to increased use of GDD for treatment of NVG [ 7 , 10 , 11 ]. Vision outcomes are thought to be poor for NVG [ 12 ], but most studies have used a limited definition of success including not progressing to no light perception (NLP) vision [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, there have been no randomized clinical trials, and only a few prospective [ 15 , 16 ] and retrospective studies [ 14 , 17 , 18 ], evaluating the outcomes of glaucoma surgery for NVG. The large prospective AVB and ABC trials were not designed with neovascular glaucoma specifically in mind but rather performed sub analyses of the small proportion of NVG patients enrolled and had a limited definition of surgical success [ 19 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…The large prospective AVB and ABC trials were not designed with neovascular glaucoma specifically in mind but rather performed sub analyses of the small proportion of NVG patients enrolled and had a limited definition of surgical success [ 19 – 21 ]. A more recent retrospective analysis of NVG surgery by Shalaby et al analyzed valved versus non-valved GDD for NVG but did not look at NVG etiology in the surgical outcomes and also used the same definition of surgical success as the prior prospective trials [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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The influence of etiology on surgical outcomes in neovascular glaucoma

et al. 2021

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Background The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD). Methods This was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision. Results One hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation. Conclusions In our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.

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“…This study echoed the findings of other important publications that both valved and non-valved GDDs performed similarly in the context of NVG [ 14 , 24 , 25 ]. Final IOP in both groups.…”

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The influence of etiology on surgical outcomes in neovascular glaucoma

et al. 2021

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“…Neovascular glaucoma (NVG) is associated with poor visual prognosis despite treatment. [ 1 2 ] The most common causes of NVG are proliferative diabetic retinopathy, ischemic central retinal vein occlusion, and ocular ischemic syndrome. [ 3 ] Retinal hypoxia stimulates the release of inflammatory cytokines, promoting fibrosis and neovascularization of the iris and anterior segment,[ 4 ] which is associated with fibrovascular membrane formation, leading to secondary angle closure and intraocular pressure (IOP) elevation.…”

mentioning

confidence: 99%

Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma

Shalaby

Ganjei

Wogu

et al. 2022

Indian J Ophthalmol

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Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single-center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ≥6 months of follow-up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 ± 0.8 vs. 1.9 ± 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP ( P = 0.001) and CPC surgery ( P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.

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Treatment Goals in Neovascular Glaucoma

Salazar

Swaminathan²

2022

Essentials in Ophthalmology

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Outcomes of Valved and Nonvalved Tube Shunts in Neovascular Glaucoma

Cited by 15 publications

References 47 publications

The influence of etiology on surgical outcomes in neovascular glaucoma

The influence of etiology on surgical outcomes in neovascular glaucoma

Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma

Treatment Goals in Neovascular Glaucoma

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