Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series

AIM:To report the outcome of Baerveldt glaucoma implant(BGI)with Supramid©ripcord use in neovascular glaucoma(NVG).METHODS:We retrospectively evaluated the surgical outcome of the BGI with Supramid©3/0 ripcord stent in patients with NVG.No tube ligation or venting slits were performed.Supramid was removed after 3mo if the target intraocular pressure(IOP)was not achieved.Surgical success was defined as IOP≤21 mm Hg with(qualified success)or without IOP-lowering medications(complete success).RESULTS:Twenty-six eyes from 24 patients were included in the study.The median duration of follow-up was 4[interquartile range(IQR)=1-5]y,ranging from 0.5 to 5y.IOP decreased by a mean of 24.2 mm Hg(59.7%);from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg,P≤0.001.The number of glaucoma medications reduced from a median of 5(IQR=5-6)to 1(IQR=0-2,P≤0.001)at the final follow-up.Overall success rates were 88.0%at 1y,34.8%at 3y,66.7%at 4y,and 50%at 5y.Hypertensive phase(HP)in the first 3mo occurred in 15/26 eyes(57.7%)with a mean IOP of 31.1 mm Hg.CONCLUSION:BGI with Supramid©ripcord stent gives close to 90%of the overall survival rate at the final follow-up without significant early hypotony.However,early HP is still a challenge.

Construction and validation of a neovascular glaucoma nomogram in patients with diabetic retinopathy after pars plana vitrectomy

BACKGROUND Neovascular glaucoma(NVG)is likely to occur after pars plana vitrectomy(PPV)for diabetic retinopathy(DR)in some patients,thus reducing the expected benefit.Understanding the risk factors for NVG occurrence and building effective risk prediction models are currently required for clinical research.AIM To develop a visual risk profile model to explore factors influencing DR after surgery.METHODS We retrospectively selected 151 patients with DR undergoing PPV.The patients were divided into the NVG(NVG occurrence)and No-NVG(No NVG occurrence)groups according to the occurrence of NVG within 6 months after surgery.Independent risk factors for postoperative NVG were screened by logistic regression.A nomogram prediction model was established using R software,and the model’s prediction accuracy was verified internally and externally,involving the receiver operator characteristic curve and correction curve.RESULTS After importing the data into a logistic regression model,we concluded that a posterior capsular defect,preoperative vascular endothelial growth factor≥302.90 pg/mL,glycosylated hemoglobin≥9.05%,aqueous fluid interleukin 6(IL-6)≥53.27 pg/mL,and aqueous fluid IL-10≥9.11 pg/mL were independent risk factors for postoperative NVG in patients with DR(P<0.05).A nomogram model was established based on the aforementioned independent risk factors,and a computer simulation repeated sampling method was used to internally and externally verify the nomogram model.The area under the curve(AUC),sensitivity,and specificity of the model were 0.962[95%confidence interval(95%CI):0.932-0.991],91.5%,and 82.3%,respectively.The AUC,sensitivity,and specificity of the external validation were 0.878(95%CI:0.746-0.982),66.7%,and 95.7%,respectively.CONCLUSION A nomogram constructed based on the risk factors for postoperative NVG in patients with DR has a high prediction accuracy.This study can help formulate relevant preventive and treatment measures.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

·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.

Ahmed青光眼阀植入术联合雷珠单抗治疗NVG患者的效果

目的:探讨Ahmed青光眼阀(AGV)植入术联合雷珠单抗治疗新生血管性青光眼(NVG)患者的效果。方法:选择2016年9月—2022年9月河池市第三人民医院收治的66例NVG患者作为研究对象,按照计算机分组法分为两组,各33例。对照组给予AGV植入术治疗,观察组在对照组基础上加用雷珠单抗治疗。比较两组临床疗效、眼压及视力的变化情况、眼动脉血流动力学及并发症发生率。结果:观察组总有效率为93.94%,高于对照组的75.76%,差异有统计学意义(P<0.05)。治疗1周、1个月、3个月后,观察组眼压水平低于对照组,术眼最佳矫正视力(BCVA)高于对照组,差异有统计学意义(P<0.05)。治疗3个月后,观察组舒张末期流速(EDV)、收缩期峰值流速(PSV)高于对照组,血流阻力指数(RI)低于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:AGV植入术联合雷珠单抗具有良好的临床疗效,可有效改善NVG患者眼动脉血流动力学指标,促进眼部血液循环,以降低眼压,提高视力,且不增加并发症发生率。

雷珠单抗预注射后再行玻璃体切割术治疗DR伴NVG患者的效果

目的:探讨雷珠单抗预注射后再行玻璃体切割术(PPV)治疗糖尿病视网膜病变(DR)伴新生血管性青光眼(NVG)患者的效果。方法:选取2020年6月—2023年6月于江南大学附属中心医院治疗的50例DR伴NVG患者作为研究对象,按随机数表法分为仅行PPV组(以下简称为PPV组,24例24眼)和雷珠单抗预注射后再行PPV组(以下简称为联合单抗组,26例26眼)。比较两组治疗前、术后3个月眼部情况、血清学指标变化,并观察两组术后并发症发生情况。结果:术后3个月,两组眼部情况、血清学指标较治疗前均改善,且联合单抗组眼压、黄斑中心凹厚度(CMT)、血管内皮生成因子(VEGF)与胰岛素样生长因子-1(IGF-1)水平低于PPV组,最佳矫正视力(BCVA)高于PPV组,差异有统计学意义(P<0.05)。联合单抗组术后并发症发生率与PPV组比较,差异无统计学意义(P>0.05)。结论:雷珠单抗预注射后再行PPV可有效降低眼压,消除黄斑水肿,促进患者术后视功能恢复,降低VEGF、IGF-1水平,且未增加并发症发生率。

雷珠单抗联合玻璃体切割术对DR伴NVG患者手术相关指标及视力恢复的影响

目的探究雷珠单抗+玻璃体切割术对糖尿病视网膜病变(Diabetic Retinopathy,DR)伴新生血管性青光眼(Neovascular Glaucoma,NVG)患者手术相关指标及视力恢复的影响。方法回顾性选取2021年9月-2023年8月烟台市中医医院眼科收治的85例DR伴NVG患者的临床资料,按治疗方式的不同分两组,对照组(n=42,共45眼)行玻璃体切割术,观察组(n=43,共47眼)予以雷珠单抗+玻璃体切割术治疗。对比两组手术相关指标、眼压及视力、眼动脉血流动力学指标、并发症发生情况。结果观察组手术时间较对照组短,电凝止血进入眼内的次数较对照组少,差异有统计学意义(P均<0.05)。对比两组术前眼压、视力、眼动脉血流动力学指标,差异无统计学意义(P均>0.05)。与对照组相比,观察组术后3个月眼压、血流阻力系数更低,最佳矫正视力、舒张末期流速、收缩峰值流速均更高,差异有统计学意义(P均<0.05)。观察组并发症总发生率较对照组低,差异有统计学意义(P<0.05)。结论在DR伴NVG患者中予以雷珠单抗、玻璃体切割术联合治疗,能够优化手术相关指标,降低眼压,改善眼动脉血流动力学指标,加快视力恢复,减少并发症。

小梁切除术、视网膜光凝联合治疗对NVG患者IP-10、TNF-α、VEGF的影响

目的分析小梁切除术、视网膜光凝联合治疗对新生血管性青光眼(NVG)患者干扰素诱导蛋白-10(IP-10)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)的影响。方法选取2019年3月至2022年8月期间保定市第一中心医院接收的103例(103眼)NVG患者,根据不同治疗方法分为观察组(小梁切除术联合视网膜光凝治疗,n=53)和对照组(睫状体冷凝术联合视网膜光凝治疗,n=50)。比较两组临床疗效及IP-10、TNF-α、VEGF水平,记录眼压、神经纤维层厚度及视野缺损值及术后并发症情况。结果观察组临床总有效率(98.11%)高于对照组(88.00%),差异有统计学意义(χ^(2)=4.154,P<0.05)。术后15 d、1个月观察组眼压低于对照组(t=5.208,P<0.05;t=4.532,P<0.05),视野缺损值低于对照组(t=2.525,P<0.05;t=5.881,P<0.05),神经纤维层厚度大于对照组(t=4.577,P<0.05;t=5.372,P<0.05),差异均有统计学意义(P<0.05)。术后1个月观察组IP-10水平高于对照组(t=3.469,P<0.05),TNF-α、VEGF水平低于对照组(t=3.938,P<0.05;t=4.024,P<0.05),差异均有统计学意义(P<0.05)。观察组视力提高率(84.91%)高于对照组(68.00%),差异有统计学意义(χ^(2)=4.114,P<0.05)。观察组并发症发生率(9.43%)低于对照组(26.00%),差异有统计学意义(χ^(2)=4.896,P<0.05)。结论小梁切除术、视网膜光凝联合治疗NVG患者的临床显著,能有效改善眼痛、畏光等症状,减少并发症的发生。

Intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma

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.

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

·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.·

Etiology, pathogenesis, and diagnosis of neovascular glaucoma

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.

Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade

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.

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

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.

Role of bevacizumab intraocular injection in the management of neovascular glaucoma

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.

Clinical efficacy of Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma with proliferative diabetic retinopathy

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.

Clinical research of EX-PRESS drainage device and modified trabeculectomy combined with intravitreal conbercept treatment for neovascular glaucoma

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.

Evaluation of Serum and Aqueous Humor Vascular Endothelial Growth Factor in Neovascular Glaucoma

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.

Simultaneous pars plana vitrectomy,panretinal photocoagulation,cryotherapy,and Ahmed valve implantation for neovascular glaucoma

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.

Prevalence, Causes and Management of Neovascular Glaucoma: A 5-Year Review

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.

Neovascular Glaucoma: An Update on Etiopathogenesis, Diagnostics and Management

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.

Neovascular Glaucoma in a Patient with X-linked Juvenile Retinoschisis

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.