·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for tre...·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.展开更多
AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected...AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation(PRP) or extra-PRP were conducted within 2 d. The follow-up time was 6 mo. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), neovascularization of iris(NVI) were recorded before and after treatment.RESULTS: Within 2 d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2 d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.展开更多
Neovascular glaucoma is defined as iris and/or anterior chamber angle neovascularization associated with increased intraocular pressure. It is a secondary glaucoma that is most frequently caused by severe retinal isch...Neovascular glaucoma is defined as iris and/or anterior chamber angle neovascularization associated with increased intraocular pressure. It is a secondary glaucoma that is most frequently caused by severe retinal ischemia. The most common diseases responsible for the development of neovascular glaucoma are diabetic retinopathy, ischemic central retinal vein occlusion,and ocular ischemic syndrome. Uncommon causes include ocular radiation, ocular tumors, uveitis and other miscellaneous conditions. Vascular endothelial growth factor is an important and likely predominant agent involved in the pathogenesis of intraocular neovascularization and neovascular glaucoma. The evolution of clinical and histopathological changes from predisposing conditions to the occurrence of rubeosis iridis and neovascular glaucoma is divided into four stages: prerubeosis, preglaucoma, open angle glaucoma, and angle-closure glaucoma.展开更多
AIM:To assess the long-term effects of intraocular bevacizumab(Avastin)injections as an adjunctive drug to manage patients with neovascular glaucoma(NVG).METHODS:A retrospective study was conducted consisting of 34 ey...AIM:To assess the long-term effects of intraocular bevacizumab(Avastin)injections as an adjunctive drug to manage patients with neovascular glaucoma(NVG).METHODS:A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy(n=25),ischemic central retinal vein occlusion(n=8),and retinal ischemia resulting from persistent detachment(n=1)were managed by intraocular injections of bevacizumab(1.25 mg/0.05 m L),in addition to other treatments.The main outcome measure was the change in the degree of iris neovascularization.Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection.RESULTS:All patients were followed-up for at least 12 mo.At the last follow-up,complete regression of rubeosis irides was detectable in 13(38.2%)eyes and incomplete regression in 21 eyes(61.8%).The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit(P=0.000005).Patients received an average of 4.97 injections.As additional treatments,12 eyes(35%)received laser photocoagulation and 6 eyes(18%)underwent retinocryopexy.No further treatment was needed in 16 eyes(47.1%).CONCLUSION:Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures.The primary cause of retinal ischemia should be always targeted.展开更多
AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retro...AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV,AGV,and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period(2005-2018).Preoperative,intraoperative and postoperative data at day 1 and months 1,3,6,21,and 24 were systematically collected.Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment.RESULTS:Main indications for surgery were NVG secondary to proliferative diabetic retinopathy(39.2%)and central retinal vein occlusion(37.3%).Mean(±SD)preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12 mo and 15.8±9.1 mm Hg at 24 mo of follow up.Cumulative incidence of success of IOP control was 76.0%at first postoperative month,reaching 88.3%at 6 mo.Prevalence of successful IOP control at long term was 74.4%at 12 mo and 71.4%at 24 mo.Eye evisceration for unsuccessful NVG management was required in 1 case(2.0%).CONCLUSION:Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.展开更多
AIM:To describe the clinical results of combined Ahmed valve implantation and 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR).METHODS:The me...AIM:To describe the clinical results of combined Ahmed valve implantation and 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR).METHODS:The medical records of medically uncontrolled NVG patients with PDR who underwent Ahmed valve implantation and 23-gauge vitrectomy between March 2016 and December 2018 were reviewed.Enrolled patients had at least 6-month follow-up.Panretinal photocoagulation(PRP),anti-vascular endothelial growth factor,surgery and medication history were documented.RESULTS:Eleven eyes of 11 patients were included in our study.The visual acuity improved in 8 eyes and remained unchanged in 3 eyes.The preoperative intraocular pressure(IOP)was significantly decreased at the last follow-up(48.8±4.3 to 17.0±1.5 mm Hg,P<0.001).All eyes needed three topical anti-glaucomatous medications before surgery,but the number was significantly reduced to 0.72±0.19 at the last visit(P<0.001).Four eyes had choroidal detachment and 3 eyes had minor hyphemia,all of which gradually resolved without treatments in one week.CONCLUSION:Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy might be a safe and alternative treatment for NVG with PDR.展开更多
AIM:To evaluate the efficacy and safety of modified trabeculectomy(experimental group) and implantation of EX-PRESS drainage device(control group),combined with intravitreal conbercept injection for neovascular glauco...AIM:To evaluate the efficacy and safety of modified trabeculectomy(experimental group) and implantation of EX-PRESS drainage device(control group),combined with intravitreal conbercept injection for neovascular glaucoma(NVG).METHODS:Totally 30 patients with NVG were selected from June 2014 to June 2017,and randomly divided into experimental group and control group.All patients were underwent intravitreal conbercept(0.5 mg/0.05 mL) treatment before surgery.Modified trabeculectomy was performed in MT group,while EX-PRESS drainage device implantation was performed in EX group.The success rates,best corrected visual acuity(BCVA),intraocular pressure(IOP),filtering bleb and complications were observed and compared.RESULTS:The differences of success rate,BCVA and filtering bleb were not statistically significant 12mo after the surgery(P>0.05),however,the difference of IOP at 1d,1wk,1,3,and 6mo after surgery was statistically significant(F_(time)=390.64,P_(time)<0.0001) between two groups.The interactions between two groups in the given time showed no significant difference(F_(intergroup×time)=0.181,P_(intergroup×time)=0.57),and also there was no significant difference in IOP between the two groups(F=3.16,P=0.09).The results of pairwise comparison at each time point showed no significant difference in IOP between 1d and 1wk,3 and 6,3mo and 12mo after surgery(P>0.05),while the results at other time point indicate statistical differences(P<0.05).CONCLUSION:The modified trabeculectomy and the implantation of EX-PRESS drainage device have clinical application value in reducing IOP and postoperative complications of refractory NVG.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 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 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
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
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
Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagula...Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagulation(PRP),and endoscopic cyclophotocoagulation(ECP)surgery for neovascular glaucoma(NVG)patients.Methods:This retrospective study included 30 patients(30 eyes)who were suffering from NVG and treated with PPV&PRP&ECP(ECP group,16 eyes),or Ahmed glaucoma valve implantation(Ahmed group,14 eyes).The intraocular pressure(IOP),number of postoperative anti-glaucoma medications,best-corrected visual acuity(BCVA),successful rate of surgery,and postoperative complications were recorded and statistically analyzed at the time points of preoperative,1-day,1-month,3-months,6-months,and 12-months after operation.Results:An obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation(P<0.05),and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months(P=0.014)and 12-months(P=0.047)postoperative time points,while there was no significant difference of medication number between the two groups except for 1-day after surgery.The BCVA showed no marked difference between the two groups preoperatively and postoperatively(P>0.05),while it was significantly improved in ECP group at 3-months(P=0.001),6-months(P=0.004),and 12-months(P=0.010)time points comparing with preoperative BCVA.The surgical success rates in ECP group were also slightly higher than Ahmed group.And the complications after operation showed no marked differences.Conclusions:The comprehensive treatment of PPV,endoscopic PRP,and ECP surgery for NVG patients after antiVEGF injection can control IOP effectively and be friendly to patients’BCVA without obvious serious complications throughout a 12-months follow-up period.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
基金Supported by Xuzhou Health Outstanding Talents Project (No.XWJC001)Critical Special Project for Social Development of Xuzhou City (No.KC21153)。
文摘·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.
基金Supported by the Natural Science Foundation of Shaanxi Province (No.2017JM8032)。
文摘AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation(PRP) or extra-PRP were conducted within 2 d. The follow-up time was 6 mo. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), neovascularization of iris(NVI) were recorded before and after treatment.RESULTS: Within 2 d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2 d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.
文摘Neovascular glaucoma is defined as iris and/or anterior chamber angle neovascularization associated with increased intraocular pressure. It is a secondary glaucoma that is most frequently caused by severe retinal ischemia. The most common diseases responsible for the development of neovascular glaucoma are diabetic retinopathy, ischemic central retinal vein occlusion,and ocular ischemic syndrome. Uncommon causes include ocular radiation, ocular tumors, uveitis and other miscellaneous conditions. Vascular endothelial growth factor is an important and likely predominant agent involved in the pathogenesis of intraocular neovascularization and neovascular glaucoma. The evolution of clinical and histopathological changes from predisposing conditions to the occurrence of rubeosis iridis and neovascular glaucoma is divided into four stages: prerubeosis, preglaucoma, open angle glaucoma, and angle-closure glaucoma.
文摘AIM:To assess the long-term effects of intraocular bevacizumab(Avastin)injections as an adjunctive drug to manage patients with neovascular glaucoma(NVG).METHODS:A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy(n=25),ischemic central retinal vein occlusion(n=8),and retinal ischemia resulting from persistent detachment(n=1)were managed by intraocular injections of bevacizumab(1.25 mg/0.05 m L),in addition to other treatments.The main outcome measure was the change in the degree of iris neovascularization.Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection.RESULTS:All patients were followed-up for at least 12 mo.At the last follow-up,complete regression of rubeosis irides was detectable in 13(38.2%)eyes and incomplete regression in 21 eyes(61.8%).The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit(P=0.000005).Patients received an average of 4.97 injections.As additional treatments,12 eyes(35%)received laser photocoagulation and 6 eyes(18%)underwent retinocryopexy.No further treatment was needed in 16 eyes(47.1%).CONCLUSION:Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures.The primary cause of retinal ischemia should be always targeted.
文摘AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV,AGV,and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period(2005-2018).Preoperative,intraoperative and postoperative data at day 1 and months 1,3,6,21,and 24 were systematically collected.Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment.RESULTS:Main indications for surgery were NVG secondary to proliferative diabetic retinopathy(39.2%)and central retinal vein occlusion(37.3%).Mean(±SD)preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12 mo and 15.8±9.1 mm Hg at 24 mo of follow up.Cumulative incidence of success of IOP control was 76.0%at first postoperative month,reaching 88.3%at 6 mo.Prevalence of successful IOP control at long term was 74.4%at 12 mo and 71.4%at 24 mo.Eye evisceration for unsuccessful NVG management was required in 1 case(2.0%).CONCLUSION:Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.
文摘AIM:To describe the clinical results of combined Ahmed valve implantation and 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR).METHODS:The medical records of medically uncontrolled NVG patients with PDR who underwent Ahmed valve implantation and 23-gauge vitrectomy between March 2016 and December 2018 were reviewed.Enrolled patients had at least 6-month follow-up.Panretinal photocoagulation(PRP),anti-vascular endothelial growth factor,surgery and medication history were documented.RESULTS:Eleven eyes of 11 patients were included in our study.The visual acuity improved in 8 eyes and remained unchanged in 3 eyes.The preoperative intraocular pressure(IOP)was significantly decreased at the last follow-up(48.8±4.3 to 17.0±1.5 mm Hg,P<0.001).All eyes needed three topical anti-glaucomatous medications before surgery,but the number was significantly reduced to 0.72±0.19 at the last visit(P<0.001).Four eyes had choroidal detachment and 3 eyes had minor hyphemia,all of which gradually resolved without treatments in one week.CONCLUSION:Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy might be a safe and alternative treatment for NVG with PDR.
基金Supported by the Social Development Project of Shaanxi Provincial Department of Science and Technology (No.2020SF-167)General Social Scientific Research Plan Project of Shaanxi Provincial Education Department in 2021 (No.21JK0891)The Innovation and Entrepreneurship Program for College Students at Xi’an Medical College (No.121521113)。
文摘AIM:To evaluate the efficacy and safety of modified trabeculectomy(experimental group) and implantation of EX-PRESS drainage device(control group),combined with intravitreal conbercept injection for neovascular glaucoma(NVG).METHODS:Totally 30 patients with NVG were selected from June 2014 to June 2017,and randomly divided into experimental group and control group.All patients were underwent intravitreal conbercept(0.5 mg/0.05 mL) treatment before surgery.Modified trabeculectomy was performed in MT group,while EX-PRESS drainage device implantation was performed in EX group.The success rates,best corrected visual acuity(BCVA),intraocular pressure(IOP),filtering bleb and complications were observed and compared.RESULTS:The differences of success rate,BCVA and filtering bleb were not statistically significant 12mo after the surgery(P>0.05),however,the difference of IOP at 1d,1wk,1,3,and 6mo after surgery was statistically significant(F_(time)=390.64,P_(time)<0.0001) between two groups.The interactions between two groups in the given time showed no significant difference(F_(intergroup×time)=0.181,P_(intergroup×time)=0.57),and also there was no significant difference in IOP between the two groups(F=3.16,P=0.09).The results of pairwise comparison at each time point showed no significant difference in IOP between 1d and 1wk,3 and 6,3mo and 12mo after surgery(P>0.05),while the results at other time point indicate statistical differences(P<0.05).CONCLUSION:The modified trabeculectomy and the implantation of EX-PRESS drainage device have clinical application value in reducing IOP and postoperative complications of refractory NVG.
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 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.
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.
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 Clinical diagnosis and treatment technology and translational application in Beijing (Z211100002921049).
文摘Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagulation(PRP),and endoscopic cyclophotocoagulation(ECP)surgery for neovascular glaucoma(NVG)patients.Methods:This retrospective study included 30 patients(30 eyes)who were suffering from NVG and treated with PPV&PRP&ECP(ECP group,16 eyes),or Ahmed glaucoma valve implantation(Ahmed group,14 eyes).The intraocular pressure(IOP),number of postoperative anti-glaucoma medications,best-corrected visual acuity(BCVA),successful rate of surgery,and postoperative complications were recorded and statistically analyzed at the time points of preoperative,1-day,1-month,3-months,6-months,and 12-months after operation.Results:An obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation(P<0.05),and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months(P=0.014)and 12-months(P=0.047)postoperative time points,while there was no significant difference of medication number between the two groups except for 1-day after surgery.The BCVA showed no marked difference between the two groups preoperatively and postoperatively(P>0.05),while it was significantly improved in ECP group at 3-months(P=0.001),6-months(P=0.004),and 12-months(P=0.010)time points comparing with preoperative BCVA.The surgical success rates in ECP group were also slightly higher than Ahmed group.And the complications after operation showed no marked differences.Conclusions:The comprehensive treatment of PPV,endoscopic PRP,and ECP surgery for NVG patients after antiVEGF injection can control IOP effectively and be friendly to patients’BCVA without obvious serious complications throughout a 12-months follow-up period.
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. 81371008） and the Science and Technology Planning Project of Guangdong Province, China （No. 2012B031800353）.
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.
