BACKGROUNDNeovascular glaucoma (NVG) is a refractory glaucoma. The management of NVG is very difficult, and it is more difficult when combined with vitreous hemorrhage. The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage.

METHODSA total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study. The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years. The mean intraocular pressure (IOP) was 46.38 ± 5.75 mmHg (1 mmHg = 0.133 kPa) while being treated with the maximum medical therapy. The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution (logMAR BCVA) was 2.62 ± 0.43. All the patients underwent intravitreal injection of 0.5 mg (0.05 ml) ranibizumab combined with pars plana vitrectomy (PPV), pars plana lensectomy (PPL) with a preserved anterior capsule, panretinal photocoagulation (PRP), and trabeculectomy (intravitreal ranibizumab [IVR] + PPV + PPL + PRP + trabeculectomy). The IOP and logMAR BCVA were the main outcome measures in this study.

RESULTSThe follow-up period was 12 months. The mean postoperative IOPs were 26.38 ± 3.75 mmHg, 21.36 ± 3.32 mmHg, 18.57 ± 3.21 mmHg, and 16.68 ± 2.96 mmHg, respectively at 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy. At the last follow-up, the mean IOP was significantly lower than the preoperative one (t = 6.612, P = 0.001). At 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy, the mean logMAR BCVA were 1.30 ± 0.36, 1.29 ± 0.37, 1.29 ± 0.39, and 1.26 ± 0.29, respectively. At the last follow-up, the mean logMAR BCVA was significantly improved, and the difference was statistically significant compared with preoperative one (t = 6.133, P = 0.002). The logMAR BCVA improved in 22 eyes (84.62%), and remained stable in 4 eyes (15.38%). The neovascularization in the iris and the angle regressed significantly in all patients 7 days after ranibizumab injection. No serious complications occurred during 12 months of the study.

CONCLUSIONSIVR + PPV + PPL + PRP + trabeculectomy can control IOP well and improve BCVA without severe complication for NVG patients with vitreous hemorrhage.

Adult ; Female ; Glaucoma, Neovascular ; drug therapy ; surgery ; Humans ; Intraocular Pressure ; drug effects ; Male ; Middle Aged ; Postoperative Complications ; Ranibizumab ; therapeutic use ; Trabeculectomy ; adverse effects ; Vitrectomy ; adverse effects ; Vitreous Hemorrhage ; drug therapy ; surgery

BACKGROUNDNeovascular glaucoma is a refractory disease, and difficult to manage. The aim of this study was to evaluate the clinical outcomes of Ahmed glaucoma valve implantation (AGVI) in neovascular glaucoma (NVG) and non-NVG patients.

METHODSThis prospective, non-randomized study included 55 eyes of 55 patients with refractory glaucoma; 27 had NVG (NVG group) and 28 had non-NVG (non-NVG group). All of the patients underwent AGVI. The NVG group was adjunctively injected with intravitreal ranibizumab/bevacizumab (IVR/IVB) before AGVI. Intraocular pressure (IOP) was the primary outcome measure in this study. Surgical success rate, number of antiglaucoma medications used, best corrected visual acuity (BCVA), and postoperative complications were analyzed between the groups.

RESULTSAll of the patients completed the study (follow-up of 12 months). Kaplan-Meier survival curve analysis indicated that the qualified success rates in the NVG and non-NVG groups at 12 months were 70.5% and 92.9%, respectively; this difference was significant (P = 0.036). The complete success rates in the NVG and non-NVG groups at 12 months were 66.7% and 89.3%, respectively (P = 0.049). Compared with preoperative examinations, the postoperative mean IOP and use of medications were significantly lower at all follow-up time points in both groups (all P < 0.05). There were significant differences in BCVA between the two groups at the 12-month follow-up (χ(2) = 9.86, P = 0.020). Cox proportional hazards regression showed NVG as a risk factor for surgical failure (RR = 15.08, P = 0.033). Postoperative complications were similar between the two groups.

CONCLUSIONSAGVI is a safe and effective procedure in refractory glaucoma, but the success rate of surgery was related to the type of refractory glaucoma. The complete and qualified success rates of NVG patient adjunctive anti-vascular endothelial growth factor treatment are still lower than those of non-NVG patients.

Adult ; Aged ; Female ; Glaucoma ; surgery ; Glaucoma Drainage Implants ; Glaucoma, Neovascular ; surgery ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies

Glaucoma, Neovascular ; drug therapy ; epidemiology ; surgery ; Humans ; Retinal Diseases ; drug therapy ; epidemiology ; surgery

PURPOSE: To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR). METHODS: The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up. RESULTS: The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 +/- 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 +/- 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 +/- 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 +/- 0.61 to 0.96 +/- 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases. CONCLUSIONS: We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.
Adult ; Aged ; Diabetic Retinopathy/*complications/pathology ; Female ; Follow-Up Studies ; *Glaucoma Drainage Implants ; Glaucoma, Neovascular/*complications/pathology/*surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vitrectomy/*methods

We report on a case of cholesterosis bulbi concurrent with secondary glaucoma. A 36-year-old man, with a history of long-standing retinal detachment in his right eye after the irrigation and aspiration of a congenital cataract, presented with a clinical picture of elevated intraocular pressure and ocular pain. Upon slit-lamp examination, we found a ciliary injection and a pseudohypopyon of polychromatic crystals. Gonioscopic examination revealed a large amount of crystals deposited on the trabecular meshwork and mild rubeosis iridis, but the neovascularization of the angle could not be clearly confirmed due to the presence of so many crystals. Pars plana vitrectomy was performed to remove clusters of crystals and bevacizumab was injected intravitreally to treat iris neovascularization. Aqueous aspirate was examined by light microscopy and the typical highly refringent cholesterol crystals were identified. Intraocular pressure returned to a normal level after the bevacizumab injection, although severe cholesterosis was still evident in the anterior chamber. To our knowledge, this would be the first Korean case of cholesterosis bulbi combined with chronic retinal detachment and presumed neovascular glaucoma, which was treated by pars plana vitrectomy and intravitreal bevacizumab injection.
Adult ; Angiogenesis Inhibitors/therapeutic use ; Anterior Chamber/*metabolism ; Antibodies, Monoclonal, Humanized/*therapeutic use ; *Cholesterol ; Eye Diseases/complications/metabolism ; Follow-Up Studies ; Glaucoma/surgery ; Glaucoma, Neovascular/drug therapy/*etiology/surgery ; Humans ; Intraocular Pressure ; Male ; Vitrectomy/*methods

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.
Adult ; Aged ; Aged, 80 and over ; Filtering Surgery/*methods ; Follow-Up Studies ; *Glaucoma Drainage Implants ; Glaucoma, Neovascular/physiopathology/*surgery ; Humans ; Intraocular Pressure ; Middle Aged ; Retrospective Studies ; Sclera/*transplantation ; *Surgical Flaps ; Treatment Outcome ; Young Adult

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.
Adult ; Aged ; Aged, 80 and over ; Filtering Surgery/*methods ; Follow-Up Studies ; *Glaucoma Drainage Implants ; Glaucoma, Neovascular/physiopathology/*surgery ; Humans ; Intraocular Pressure ; Middle Aged ; Retrospective Studies ; Sclera/*transplantation ; *Surgical Flaps ; Treatment Outcome ; Young Adult

This prospective observational case series study included 6 eyes of 6 consecutive glaucomatous patients. Each patient underwent trabeculectomy with mitomycin C, and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the trabeculectomy. Study eyes included two with neovascular glaucoma, three with uveitic glaucoma, and one with secondary glaucoma following vitrectomy. All eyes had undergone failed glaucoma laser/surgical treatment or an intraocular surgical procedure. Intraocular pressure (IOP) at the following postoperative visits: preoperative, 1 week, 1 month, 2 months, 3 months, and 6 months, was measured. We also evaluated postoperative bleb findings and complications. IOP measured at each visit was 37.5+/-14.4 mmHg, 6.2+/-3.4 mmHg, 8.3+/-7.2 mmHg, 12.0+/-4.4 mmHg, 10.8+/-3.1 mmHg, and 12.2+/-3.3 mmHg, respectively, for each visit. All eyes had functioning blebs with normal IOP at postoperative 6 months with no additional IOP-lowering medication.
Adult ; Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Conjunctiva ; Female ; Glaucoma/*drug therapy/etiology/*surgery ; Glaucoma, Neovascular/drug therapy/surgery ; Humans ; Injections, Intraocular ; Male ; Middle Aged ; Prospective Studies ; Trabeculectomy/*methods ; Uveitis/complications ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Vitrectomy/adverse effects

A 13-year-old girl with a right intraorbital optic nerve glioma (ONG) was referred to our glaucoma clinic because of uncontrolled intraocular pressure (IOP) in her right eye. The IOP reached as high as 80 mmHg. Several months earlier, she had undergone stereotactic image-guided robotic radiosurgery using the CyberKnife for her ONG; the mass had become smaller after treatment. Her visual acuity was no light perception. Slit lamp examination revealed rubeosis iridis, a swollen pale optic disc, and vitreous hemorrhage. After medical treatment, the IOP decreased to 34 mmHg, and no pain was reported. Although the mass effect of an ONG can cause neovascular glaucoma (NVG), this case shows that stereotactic radiosurgery may also cause NVG, even after reducing the mass of the tumor. Patients who undergo radiosurgery targeting the periocular area should be followed carefully for complications.
Adolescent ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*etiology/physiopathology ; Glioma/diagnosis/*surgery ; Gonioscopy ; Humans ; Intraocular Pressure ; Magnetic Resonance Imaging ; Optic Nerve Neoplasms/diagnosis/*surgery ; Radiosurgery/*adverse effects

No abstract available.
Dose-Response Relationship, Radiation ; Glaucoma, Neovascular/*etiology ; Glioma/*surgery ; Humans ; Optic Nerve Neoplasms/*surgery ; Radiosurgery/*adverse effects