AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study i...AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure(IOP) number of anti-glaucoma medications, visual acuity(VA), surgical success rates,and complications were recorded.RESULTS:AfterAGVimplantation,IOPwas18.2±4.0mmHg,15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36 mo,significantly decreased compared with pre-IOP(P <0.01).The number of anti-glaucoma medications was 0.9 ±0.5,0.8 ±0.9 and 0.8 ±0.6 at 6, 12 and 36 mo, significantly decreased compared to pre-treatment(P <0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%,74.1% and 71.0% at 12, 24 and 36 mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity <2/400(P <0.05). Post-operative complications occurred in 8eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes.CONCLUSION:The procedure of preoperative IVB andAGV implantation should be one of treatments for NVG because of its safety and effectiveness.展开更多
AIM: To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR). ·METHODS: Twelve m...AIM: To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR). ·METHODS: Twelve medically uncontrolled NVG with earlier 23 -gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best -corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up. ·RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5 ± 1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow -up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention. ·CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.展开更多
Purpose: The study aimed to evaluate and correlate between the levels of vascular endothelial growth factor (VEGF) in serum and aqueous humor in cases of neovascular glaucoma (NVG) to stand up on if it can be used as ...Purpose: The study aimed to evaluate and correlate between the levels of vascular endothelial growth factor (VEGF) in serum and aqueous humor in cases of neovascular glaucoma (NVG) to stand up on if it can be used as a marker for early detection of such cases. Methods: This observational case control study included 60 eyes, divided into 3 groups, group A of 30 eyes presented by cataract of different causes (not diabetic patients and no signs of NVG) as a control group and group B of 30 eyes with NVG due to different causes, group C of the same eyes in group B but after one month of treatment by intravitreal bevacizumab and laser treatment by pan retinal photocoagulation (PRP). Serum VEGF was estimated in all groups, also aqueous humor VEGF was estimated in group A and B only. In addition glycosylated hemoglobin (HbA1c) was estimated in group B;statistical analysis of the results was performed. Results: The study revealed that the commonest cause of NVG was proliferative diabetic retinopathy (PDR) in 26 cases (86.7%), HbA1c in group B revealed mean value 7.68% ± 2.75%. Serum VEFG level in the group B of cases of NVG was significantly higher than the control group A (P 0.05). Conclusions: VEGF is considered a good marker for the NVG either in serum or aqueous humor, laser treatment and the use of anti-VEGF are crucial treatment for such cases, and also glycemic control is a must for regulation of the vascular process in diabetic patients for prevention of such ocular neovascularization.展开更多
Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of o...Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. Methods: The case records of all patients who were managed in the department of ophthalmology from January 2013 to December 2017 for neovascular glaucoma were retrieved. Data collected included, age, sex, causes of neovascular glaucoma, presenting visual acuity, treatment options and outcomes, systemic and ocular comorbidities. Results were analysed using Statistical Package for Social Sciences (SPSS) 20.0 for Windows statistical software. Results: Thirty-two eyes (32) of twenty-eight patients were studied. The hospital prevalence of neovascular glaucoma was 0.3%. There were 4 cases of bilateral neovascular glaucoma (NVG). Retinal vein occlusion 17 (53%) was the commonest cause of NVG followed by proliferative diabetic retinopathy 13 (41%). Uveitis was seen in only 2 (6%) eyes. The commonest form of intervention used was a combination of medical therapy and anti VEGFs. Fifty percent (50%) of the study population had a lowering of their intraocular pressures within the normal limits post treatment and this was statistically significant (p = 0.000). However, only 10% had an improvement in their visual acuity after treatment. Conclusions: Neovascular glaucoma is a potential blinding condition with challenges in control of intraocular pressures and preservation of vision. Early detection and attention to aetiological factors with timely institution of the appropriate mode of treatment may help in preserving vision.展开更多
Neovascular glaucoma (NVG) is a severe secondary and refractory *severe secondary conditio, that accounts for a varying prevalence between 0.01% to 5.1% of all glaucoma those studied in different regions of the world....Neovascular glaucoma (NVG) is a severe secondary and refractory *severe secondary conditio, that accounts for a varying prevalence between 0.01% to 5.1% of all glaucoma those studied in different regions of the world. **This is a pathological condition, which is caused by the new vessels over iris surface and followed by fibrovascular membrane formation over the trabecular meshwork, secondary to a local angiogenic stimulus. The fibrovascular membrane over trabecular meshwork obstructs the aqueous outflow at an angle of the anterior chamber. ***The obstruction in outflow of the aqueous results increase of intraocular pressure (IOP), within the eyeball. NVG results from a number of ocular and systemic conditions with retinal ischemia leading to anoxia as a mediator in over 95% of cases. Most of them are affected with proliferative diabetic retinopathy (PDR) followed by central retinal venous occlusion (CRVO), and ocular ischemic syndrome (OIS) along with other uncommon causes or all those causes that causes retinal anoxia which led to angiogenic activity in retina and iris of eye. Although NVG overall prevalence is low, but it is a dreadful condition led to blindness. The objective of this review is to provide detailed information on its basic and clinical aspects, to enable us to manage it logically. Here its etiopathogenesis, methods of early diagnosis and management are discussed. It was concluded that if NVG is detected earlier and managed systematically (both medical and surgical) along with an eye on alleviation of different aggravating factors of the retinal hypoxia, it could be a sight-saving measure to the affected person.展开更多
AIM:To evaluate the efficacy and safety of intravitreal ranibizumab(IVR)with panretinal photocoagulation(PRP)followed by trabeculectomy compared with Ahmed glaucoma valve(AGV)implantation in neovascular glaucoma(NVG)....AIM:To evaluate the efficacy and safety of intravitreal ranibizumab(IVR)with panretinal photocoagulation(PRP)followed by trabeculectomy compared with Ahmed glaucoma valve(AGV)implantation in neovascular glaucoma(NVG).METHODS:This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included:diabetic retinopathy(25 eyes),and retinal vein occlusion(20 eyes).All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities(BCVA)were converted to the logarithms of the minimum angle of resolution(log MAR)for the statisitical analyses.Intraocular pressure(IOP),the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS:A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery(F=545.468,P<0.05),and the mean postoperative log MAR BCVA was also significantly improved(F=10.964,P<0.05)with no significant difference between two groups.CONCLUSION:It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.展开更多
Purpose: To report the rubeosis iridis and neovascular glaucoma findings in one patient of X-linked juvenile retinoschisis (XLRS).Methods: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan were p...Purpose: To report the rubeosis iridis and neovascular glaucoma findings in one patient of X-linked juvenile retinoschisis (XLRS).Methods: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan were performed in a patient with X-linked juvenile retinoschisis complicated with neovascular glaucoma.Result: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan unveiled a rare condition of XLRS complicated with neovascular glaucoma.Conclusion: XLRS may complicate with neovascular glaucoma. It is necessary to test OCT, FFA, ERG and carefully examine the fundus of the follow eye when it comes to uncertain neovascular glaucoma of youth and child. And only in this way, can we exclude XLRS.展开更多
The prevalence of eye diseases worldwide is dramatically increasing and represents a major concern in underdeveloped and developed regions. Ocular diseases, previously associated with a higher depression risk, also im...The prevalence of eye diseases worldwide is dramatically increasing and represents a major concern in underdeveloped and developed regions. Ocular diseases, previously associated with a higher depression risk, also impose a substantial economic burden on affected families, thus early detection and/or accurate treatment in order to avoid and prevent blindness should be emphasized. Ocular neovascularization(NV), the leading cause of blindness in a variety of eye diseases, is a pathologic process characterized by the formation, proliferation and infiltration of anomalous, tiny and leaky fragile blood vessels within the eye. Genetics have been suspected to play an important role in the occurrence of eye diseases, with the detection of a numbers of specific gene mutations. Long non-coding RNA(lnc RNAs) are novel class of regulatory molecules previously associated with various biological processes and diseases, however the nature of the relation and pathways by which they might contribute to the development of corneal, choroidal and retinal NV have not yet been completely elucidated. In this review, we focus on the regulation and characteristics of lncR NAs, summarize results from ocular NV-related studies and discuss the implication of lncR NAs in ocular NV development.展开更多
AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery.METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medic...AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery.METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure(IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120m o with a mean follow-up of 63.2m o. IOP before the operation decreased from 31.6±10.4 mmHg to 18.3±5.4 mm Hg(no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference(P<0.001). The success rate was 85.2% during the first semester, 76.8% at 12 mo and 50.3% at the end of follow up period(18 to 120 mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6%(phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%.CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.展开更多
AIM: To evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant(PPV-BGI)placement for refractory glaucoma.·METHODS: The medical records of 92 eyes(89patients) that underwent PPV-BGI wer...AIM: To evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant(PPV-BGI)placement for refractory glaucoma.·METHODS: The medical records of 92 eyes(89patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma(NVG) and 49 eyes with other types of glaucoma(non-NVG).·RESULTS: Outcome measures were visual acuity(VA),intraocular pressure(IOP), glaucoma medical therapy,complications, and success [VA >hand motions(HM),IOP ≥6 mm Hg and ≤21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at1 y, respectively(P =0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP(mean±SD) was 30.3±11.7 mm Hg in the Non-NVG group and 40.0 ±10.6 mm Hg in the NVG group, and IOP was reduced to 15±9.5 mm Hg in the non-NVG group and 15±10.5 mm Hg in the NVG at 1y. Number of glaucoma medications(mean ±SD) decreased from 2.7 ±1.3 in the non-NVG group and 2.8 ±1.3 in the NVG group preoperatively to 0.76 ±1.18 in the non-NVG group and0.51±1.00 in the NVG group at 1y. Improvement in VA of≥2 Snellen lines was observed in 25(27%) eyes,although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearingvitreous hemorrhage was the most common postoperative complication occurring in 16(17%) eyes,and postoperative suprachoroidal hemorrhages developed in 5(5.4%) eyes.·CONCLUSION: PPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities,especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.展开更多
Neovascular glaucoma (NVG) is a blinding,intractable disease,which is difficult to manage.It is referred to as an "end-stage" ocular disease.Conventional treatments for extremely uncontrolled NVG cases inclu...Neovascular glaucoma (NVG) is a blinding,intractable disease,which is difficult to manage.It is referred to as an "end-stage" ocular disease.Conventional treatments for extremely uncontrolled NVG cases include retinal cryotherapy or enucleation.Major advancements in the diagnosis and the treatment of NVG,such as glaucoma drainage implant surgery and anti-vascular endothelial growth factor (anti-VEGF) treatment,have led to a new era in the management of this condition.However,many challenges still remain to be overcome.展开更多
Purpose: To report a case of bilateral regression of anterior segment neovascularisation after carotid endarterectomy in a patient with bilateral ocular ischaemic syndrome (OIS). Patient and Methods: Case report. A 61...Purpose: To report a case of bilateral regression of anterior segment neovascularisation after carotid endarterectomy in a patient with bilateral ocular ischaemic syndrome (OIS). Patient and Methods: Case report. A 61 year-old man suffering from bilateral ocular ischaemic syndrome causing iris neovascularisation (NVI) and neovascular glaucoma (NVG), was planned for bilateral panretinal photocoagulation (PRP) and endarterectomy. PRP was technically only possible in his right eye, while endarterectomy was performed in both carotids. Results: Bilateral complete NVI regression was observed a month after surgery. Conclusion: In some OIS uveal ischaemia could be the major responsible for NVI. Carotid endarterectomy benefits patients who have more than 70% stenosis and improves ocular blood flow, so it should be considered in patients suffering OIS with NVI unre- spective of other cerebral ischaemic symptoms.展开更多
哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)是一种蛋白激酶,在体内主要参与营养水平、生长代谢的调节。mTOR是癌症、衰老和其他代谢相关病理性疾病的重要靶点,参与了增殖、转分化、自噬等多种生物学过程。眼被认为是...哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)是一种蛋白激酶,在体内主要参与营养水平、生长代谢的调节。mTOR是癌症、衰老和其他代谢相关病理性疾病的重要靶点,参与了增殖、转分化、自噬等多种生物学过程。眼被认为是具有免疫特权的区域,由于血管系统会影响视力,眼的血管系统位于中心光路以外。眼的许多区域都有将免疫细胞运输至发育不良、受损或衰老有关的病变部位的机制。尽管免疫应答主要是为了修复或保护自身,但是免疫细胞可能会分泌一些细胞因子,导致炎症或纤维化,进而损害视力。研究证实,mTOR与翼状胬肉、年龄相关性黄斑变性(age-related macular degeneration,AMD)、青光眼、白内障、糖尿病视网膜病变(diabetic retinopathy,DR)、眼部肿瘤等多种眼病密切相关。目前,mTOR抑制剂通常被用作免疫抑制剂,用于癌症的治疗,但mTOR抑制剂用于眼部疾病的报道尚少。因此,该文就mTOR信号通路在相关眼科疾病中的作用、调控机制、药物治疗等方面进行简要综述,为相关眼科疾病的病理机制与治疗提供思路,以便后续开展更深入的研究。展开更多
文摘AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure(IOP) number of anti-glaucoma medications, visual acuity(VA), surgical success rates,and complications were recorded.RESULTS:AfterAGVimplantation,IOPwas18.2±4.0mmHg,15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36 mo,significantly decreased compared with pre-IOP(P <0.01).The number of anti-glaucoma medications was 0.9 ±0.5,0.8 ±0.9 and 0.8 ±0.6 at 6, 12 and 36 mo, significantly decreased compared to pre-treatment(P <0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%,74.1% and 71.0% at 12, 24 and 36 mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity <2/400(P <0.05). Post-operative complications occurred in 8eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes.CONCLUSION:The procedure of preoperative IVB andAGV implantation should be one of treatments for NVG because of its safety and effectiveness.
基金Shanghai Leading Academic Discipline Project, China (No.S30205)
文摘AIM: To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR). ·METHODS: Twelve medically uncontrolled NVG with earlier 23 -gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best -corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up. ·RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5 ± 1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow -up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention. ·CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.
文摘Purpose: The study aimed to evaluate and correlate between the levels of vascular endothelial growth factor (VEGF) in serum and aqueous humor in cases of neovascular glaucoma (NVG) to stand up on if it can be used as a marker for early detection of such cases. Methods: This observational case control study included 60 eyes, divided into 3 groups, group A of 30 eyes presented by cataract of different causes (not diabetic patients and no signs of NVG) as a control group and group B of 30 eyes with NVG due to different causes, group C of the same eyes in group B but after one month of treatment by intravitreal bevacizumab and laser treatment by pan retinal photocoagulation (PRP). Serum VEGF was estimated in all groups, also aqueous humor VEGF was estimated in group A and B only. In addition glycosylated hemoglobin (HbA1c) was estimated in group B;statistical analysis of the results was performed. Results: The study revealed that the commonest cause of NVG was proliferative diabetic retinopathy (PDR) in 26 cases (86.7%), HbA1c in group B revealed mean value 7.68% ± 2.75%. Serum VEFG level in the group B of cases of NVG was significantly higher than the control group A (P 0.05). Conclusions: VEGF is considered a good marker for the NVG either in serum or aqueous humor, laser treatment and the use of anti-VEGF are crucial treatment for such cases, and also glycemic control is a must for regulation of the vascular process in diabetic patients for prevention of such ocular neovascularization.
文摘Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. Methods: The case records of all patients who were managed in the department of ophthalmology from January 2013 to December 2017 for neovascular glaucoma were retrieved. Data collected included, age, sex, causes of neovascular glaucoma, presenting visual acuity, treatment options and outcomes, systemic and ocular comorbidities. Results were analysed using Statistical Package for Social Sciences (SPSS) 20.0 for Windows statistical software. Results: Thirty-two eyes (32) of twenty-eight patients were studied. The hospital prevalence of neovascular glaucoma was 0.3%. There were 4 cases of bilateral neovascular glaucoma (NVG). Retinal vein occlusion 17 (53%) was the commonest cause of NVG followed by proliferative diabetic retinopathy 13 (41%). Uveitis was seen in only 2 (6%) eyes. The commonest form of intervention used was a combination of medical therapy and anti VEGFs. Fifty percent (50%) of the study population had a lowering of their intraocular pressures within the normal limits post treatment and this was statistically significant (p = 0.000). However, only 10% had an improvement in their visual acuity after treatment. Conclusions: Neovascular glaucoma is a potential blinding condition with challenges in control of intraocular pressures and preservation of vision. Early detection and attention to aetiological factors with timely institution of the appropriate mode of treatment may help in preserving vision.
文摘Neovascular glaucoma (NVG) is a severe secondary and refractory *severe secondary conditio, that accounts for a varying prevalence between 0.01% to 5.1% of all glaucoma those studied in different regions of the world. **This is a pathological condition, which is caused by the new vessels over iris surface and followed by fibrovascular membrane formation over the trabecular meshwork, secondary to a local angiogenic stimulus. The fibrovascular membrane over trabecular meshwork obstructs the aqueous outflow at an angle of the anterior chamber. ***The obstruction in outflow of the aqueous results increase of intraocular pressure (IOP), within the eyeball. NVG results from a number of ocular and systemic conditions with retinal ischemia leading to anoxia as a mediator in over 95% of cases. Most of them are affected with proliferative diabetic retinopathy (PDR) followed by central retinal venous occlusion (CRVO), and ocular ischemic syndrome (OIS) along with other uncommon causes or all those causes that causes retinal anoxia which led to angiogenic activity in retina and iris of eye. Although NVG overall prevalence is low, but it is a dreadful condition led to blindness. The objective of this review is to provide detailed information on its basic and clinical aspects, to enable us to manage it logically. Here its etiopathogenesis, methods of early diagnosis and management are discussed. It was concluded that if NVG is detected earlier and managed systematically (both medical and surgical) along with an eye on alleviation of different aggravating factors of the retinal hypoxia, it could be a sight-saving measure to the affected person.
文摘AIM:To evaluate the efficacy and safety of intravitreal ranibizumab(IVR)with panretinal photocoagulation(PRP)followed by trabeculectomy compared with Ahmed glaucoma valve(AGV)implantation in neovascular glaucoma(NVG).METHODS:This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included:diabetic retinopathy(25 eyes),and retinal vein occlusion(20 eyes).All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities(BCVA)were converted to the logarithms of the minimum angle of resolution(log MAR)for the statisitical analyses.Intraocular pressure(IOP),the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS:A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery(F=545.468,P<0.05),and the mean postoperative log MAR BCVA was also significantly improved(F=10.964,P<0.05)with no significant difference between two groups.CONCLUSION:It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.
文摘Purpose: To report the rubeosis iridis and neovascular glaucoma findings in one patient of X-linked juvenile retinoschisis (XLRS).Methods: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan were performed in a patient with X-linked juvenile retinoschisis complicated with neovascular glaucoma.Result: Color fundus photography, fluorescein angiography (FFA), OCT and B-scan unveiled a rare condition of XLRS complicated with neovascular glaucoma.Conclusion: XLRS may complicate with neovascular glaucoma. It is necessary to test OCT, FFA, ERG and carefully examine the fundus of the follow eye when it comes to uncertain neovascular glaucoma of youth and child. And only in this way, can we exclude XLRS.
基金Supported by the National Natural Science Foundation of China (No.81170887)the Natural Science Foundation of Guangdong Province (No.2017A030313602)the Horizontal Topic Matching Funds of Nanfang Hospital, Southern Medical University (No.G201202)
文摘The prevalence of eye diseases worldwide is dramatically increasing and represents a major concern in underdeveloped and developed regions. Ocular diseases, previously associated with a higher depression risk, also impose a substantial economic burden on affected families, thus early detection and/or accurate treatment in order to avoid and prevent blindness should be emphasized. Ocular neovascularization(NV), the leading cause of blindness in a variety of eye diseases, is a pathologic process characterized by the formation, proliferation and infiltration of anomalous, tiny and leaky fragile blood vessels within the eye. Genetics have been suspected to play an important role in the occurrence of eye diseases, with the detection of a numbers of specific gene mutations. Long non-coding RNA(lnc RNAs) are novel class of regulatory molecules previously associated with various biological processes and diseases, however the nature of the relation and pathways by which they might contribute to the development of corneal, choroidal and retinal NV have not yet been completely elucidated. In this review, we focus on the regulation and characteristics of lncR NAs, summarize results from ocular NV-related studies and discuss the implication of lncR NAs in ocular NV development.
文摘AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery.METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure(IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120m o with a mean follow-up of 63.2m o. IOP before the operation decreased from 31.6±10.4 mmHg to 18.3±5.4 mm Hg(no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference(P<0.001). The success rate was 85.2% during the first semester, 76.8% at 12 mo and 50.3% at the end of follow up period(18 to 120 mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6%(phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%.CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.
文摘AIM: To evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant(PPV-BGI)placement for refractory glaucoma.·METHODS: The medical records of 92 eyes(89patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma(NVG) and 49 eyes with other types of glaucoma(non-NVG).·RESULTS: Outcome measures were visual acuity(VA),intraocular pressure(IOP), glaucoma medical therapy,complications, and success [VA >hand motions(HM),IOP ≥6 mm Hg and ≤21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at1 y, respectively(P =0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP(mean±SD) was 30.3±11.7 mm Hg in the Non-NVG group and 40.0 ±10.6 mm Hg in the NVG group, and IOP was reduced to 15±9.5 mm Hg in the non-NVG group and 15±10.5 mm Hg in the NVG at 1y. Number of glaucoma medications(mean ±SD) decreased from 2.7 ±1.3 in the non-NVG group and 2.8 ±1.3 in the NVG group preoperatively to 0.76 ±1.18 in the non-NVG group and0.51±1.00 in the NVG group at 1y. Improvement in VA of≥2 Snellen lines was observed in 25(27%) eyes,although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearingvitreous hemorrhage was the most common postoperative complication occurring in 16(17%) eyes,and postoperative suprachoroidal hemorrhages developed in 5(5.4%) eyes.·CONCLUSION: PPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities,especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.
基金This research was supported by grants from the National Natural Science Foundation of China （No. 81371008） and the Science and Technology Planning Project of Guangdong Province, China （No. 2012B031800353）.
基金ZHOU Min-wen and WANG Wei contributed equallyto this study. This research was supported by grants from the National Natural Science Foundation of China （No. 81170849）, and the Fundamental Research Funds of State Key Laboratory of Ophthalmology （No. 2011 C02）.
基金This research was supported by grants from the National Natural Science Foundation of China （No. 81170849 and No. 81371008）. Conflicts of interest： none.
文摘Neovascular glaucoma (NVG) is a blinding,intractable disease,which is difficult to manage.It is referred to as an "end-stage" ocular disease.Conventional treatments for extremely uncontrolled NVG cases include retinal cryotherapy or enucleation.Major advancements in the diagnosis and the treatment of NVG,such as glaucoma drainage implant surgery and anti-vascular endothelial growth factor (anti-VEGF) treatment,have led to a new era in the management of this condition.However,many challenges still remain to be overcome.
文摘Purpose: To report a case of bilateral regression of anterior segment neovascularisation after carotid endarterectomy in a patient with bilateral ocular ischaemic syndrome (OIS). Patient and Methods: Case report. A 61 year-old man suffering from bilateral ocular ischaemic syndrome causing iris neovascularisation (NVI) and neovascular glaucoma (NVG), was planned for bilateral panretinal photocoagulation (PRP) and endarterectomy. PRP was technically only possible in his right eye, while endarterectomy was performed in both carotids. Results: Bilateral complete NVI regression was observed a month after surgery. Conclusion: In some OIS uveal ischaemia could be the major responsible for NVI. Carotid endarterectomy benefits patients who have more than 70% stenosis and improves ocular blood flow, so it should be considered in patients suffering OIS with NVI unre- spective of other cerebral ischaemic symptoms.
