The objective of this research is to examine the visual outcome of diabetic vitrectomy depending on each indication, to examine the factors influential to last visual acuity, to identify the causes for low vision and to learn the frequency of postoperative complications. Risk factors for the development of neovascular glaucoma either preoperative or intraoperative were carefully evaluated. Postoperative visual improvement was achieved in 67 eyes[53.6%]of 97 patients[125 eyes]who had undergone surgery due to diabetic retinopathy. Anatomical success was achieved in 111 eyes[88.8%]and vision better than 5/200 in 54 eyes [43.2%]. Statistically significant improvement of vision was obtained among the patients who had been controlling their blood sugar level successfully. Postoperative complications such as rubeosis iridis or neo-vascular glaucoma proved to be detrimental to visual outcome. Neovascular glaucoma occured in 20 eyes among the total 125 eyes[16%]and more frequently associated in eyes with postoperative retinal detachment[37.5%]than in eyes without retinal detachment[12.8%]. The difference was significant statistically. To summarize :first, thorough control of blood sugar level is indispensible in order to reduce postoperative visual loss and obtain the maximum effect of diabetic vitrectomy, second, postoperative occurrence of retinal detachment is at high risk for developing neovascular glaucoma.
Blood Glucose ; Diabetic Retinopathy* ; Glaucoma ; Glaucoma, Neovascular ; Humans ; Postoperative Complications ; Retinal Detachment ; Retinaldehyde ; Risk Factors ; Vision, Low ; Visual Acuity ; Vitrectomy*

We performed a retrospective study of serum factors associated with neovascular glaucoma that can occur following vitrectomy for proliferative diabetic retinopathy. The medical records of 183 patients (241 eyes) who received vitrectomy between August 1996 and August 2000 were studied retrospectively and subsequently analyzed by linear logistic regression analysis and multiple logistic regression tests. Neovascular glaucoma developed at an average of 2.7 months in 31 of 241 eyes (14.1%). The overall anatomical success rate of retinal attachment was 82.5% (199 eyes in 241 eyes), although it decreased to 45.1% (14 eyes in 31 eyes) in eyes with neovascular glaucoma. Serum cholesterol (P = 0.041) and fibrinogen levels (P = 0.020) were significantly associated with the development of neovascular glaucoma. However, no significant association could be found concerning hypertension, diabetic retinopathy or hypercholesterolemia (P > 0.05). We suggest that serum creatinine, cholesterol and fibrinogen levels can be used to predict the development of neovascular glaucoma in vitrectomized eyes with diabetic retinopathy and can further provide a more active approach to preventing the development of this condition.
Adult ; Aged ; Aged, 80 and over ; Blood/metabolism ; Cell Division ; Diabetic Retinopathy/*pathology/*surgery ; Glaucoma, Neovascular/*blood/*complications ; Human ; Middle Age ; Postoperative Period ; Retrospective Studies ; *Vitrectomy

PURPOSE: The surgical outcome of diabetic vitrectomy, prognostic factors influential to development of postoperative complications and possible risk factors of postoperative neovascular glaucoma which is main cause of blindness were evaluated. METHODS: The medical records of 56 eyes in 51 patients who underwent vitrectomy for proliferative diabetic retinopathy were reviewed. RESULTS: Anatomical success was achieved in 50 eyes (89%) and vision better than 5/200 in 39 eyes (70%) of 56 eyes that had undergone vitrectomy due to diabetic retinopahty. Statistically significant improvement of vision was obtained among the patients who had preoperative visual acuity of 5/200 or better (p<0.05). Postoperative complication such as neovascular glaucoma proved to be detrimental to visual outcome. The causes of poor visual outcome included neovascular glaucoma, optic atrophy, cataract, macular edema, subretinal hemorrhage, macular subretinal fibrosis, and vitreous hemorrhage. Neovascular glaucoma occurred in 5 eyes among the total 56 eyes (9%). There was no statistically different result in the incidence of neovascular glaucoma according to preoperative panretinal photocoagulation, intraoperative cataract extraction, postoperative retinal detachment, intraocular gas or oil injection, duration of diabetes, control of blood sugar and presence of diabetic nephropathy. CONCLUSIONS: The visual prognosis of diabetic vitrectomy is related with preoperative visual acuity. As neovasular glaucoma is detrimental to visual outcome, it is important to find postoperative neovascularizaton on iris as soon as possible and effective treatment is also important.
Blindness ; Blood Glucose ; Cataract ; Cataract Extraction ; Diabetic Nephropathies ; Diabetic Retinopathy* ; Fibrosis ; Glaucoma ; Glaucoma, Neovascular ; Hemorrhage ; Humans ; Incidence ; Iris ; Light Coagulation ; Macular Edema ; Medical Records ; Optic Atrophy ; Postoperative Complications* ; Prognosis ; Retinal Detachment ; Risk Factors ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

We report a case of ocular ischemic syndrome accompanied by neovascular glaucoma that was successfully treated with Bevacizumab. A 70-year-old male patient diagnosed with neovascular glaucoma of the left eye 3-4 years prior complained of continuous left eye pain and declining visual acuity despite receiving the latest treatment methods. At the time of admission the patient had no light perception in the left eye and his intraocular pressure was 30 mmHg. Anterior segment and fundus examinations revealed neovascularization of the iris and stenosis of the retinal vessel. Hypofluorescence of the choroid and retinal vessels was observed on fluorescence fundus angiography. Left internal carotid artery stenosis was observed on a brain MRI. Despite being treated with eye solution and oral medication, intraocular pressure was not controlled. After 7 days, we performed an intravitreal Bevacizumab 1.25 mg/0.05mL injection. One day after the intravitreal Bevacizumab injection, the neovascularization had nearly regressed and intraocular pressure was 30 mmHg. Intravitreal Bevacizumab injection produced regression of neovascularization and proved effective for treatment of neovascular glaucoma in this case of ocular ischemic syndrome.
Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Carotid Stenosis/*complications/diagnosis ; Diagnosis, Differential ; Eye/*blood supply ; Fluorescein Angiography ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*drug therapy/etiology ; Humans ; Injections ; Ischemia/*complications/diagnosis ; Magnetic Resonance Angiography ; Male ; Vascular Endothelial Growth Factor A ; Vitreous Body

We report a case of ocular ischemic syndrome accompanied by neovascular glaucoma that was successfully treated with Bevacizumab. A 70-year-old male patient diagnosed with neovascular glaucoma of the left eye 3-4 years prior complained of continuous left eye pain and declining visual acuity despite receiving the latest treatment methods. At the time of admission the patient had no light perception in the left eye and his intraocular pressure was 30 mmHg. Anterior segment and fundus examinations revealed neovascularization of the iris and stenosis of the retinal vessel. Hypofluorescence of the choroid and retinal vessels was observed on fluorescence fundus angiography. Left internal carotid artery stenosis was observed on a brain MRI. Despite being treated with eye solution and oral medication, intraocular pressure was not controlled. After 7 days, we performed an intravitreal Bevacizumab 1.25 mg/0.05mL injection. One day after the intravitreal Bevacizumab injection, the neovascularization had nearly regressed and intraocular pressure was 30 mmHg. Intravitreal Bevacizumab injection produced regression of neovascularization and proved effective for treatment of neovascular glaucoma in this case of ocular ischemic syndrome.
Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Carotid Stenosis/*complications/diagnosis ; Diagnosis, Differential ; Eye/*blood supply ; Fluorescein Angiography ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*drug therapy/etiology ; Humans ; Injections ; Ischemia/*complications/diagnosis ; Magnetic Resonance Angiography ; Male ; Vascular Endothelial Growth Factor A ; Vitreous Body