Efficacy of a combination of conservative and surgical methods of treatment for neovaascular glaucoma associated with diabetic retinopathy and central or branch retinal vein occlusion

Authors

DOI:

https://doi.org/10.31288/oftalmolzh202431623

Keywords:

secondary neovascular glaucoma, retinal laser photocoagulation, intravitreal anti-VEGF injection, ranibizumab, glaucoma surgery, intraocular pressure

Abstract

Background: Neovascular glaucoma (NVG) is secondary glaucoma which is often resistant to medical therapy and may potentially lead to blindness.

Purpose: To assess the efficacy of a combination of conservative and surgical methods of treatment for NVG associated with proliferative diabetic retinopathy (PDR) and central or branch retinal vein occlusion (CRVO or BRVO).

Material and Methods: Fifty-six patients (68 eyes) with NVG were under our observation. These included 48 patients (60 eyes) with NVG associated with PDR and 8 patients (8 eyes) with NVG associated with CRVO or BRVO. The mean patient age was 64.0 ± 10.0 years. Group 1 (22 patients, 33 eyes) received hypotensive ocular hypotensive medication, retinal laser photocoagulation and intravitreal ranibizumab. In addition to the above treatment, group 2 (34 patients, 35 eyes) received filtration surgery. Of the 68 eyes, 24 received single ranibizumab 0.5 mg injection; 26 eyes, two to four injections, and 18 eyes, five or more injections.

Results: The treatment resulted in a partial reduction in iris neovascularization in 53/68 eyes, and total reduction, in 15/68 eyes. In a total sample of patients, the IOP reduced from 29.1 ± 7.9 mmHg at baseline to 20.4 ± 4.8 mmHg after treatment, and the mean number of IOP-lowering medications, from 2.1 ± 1.1 at baseline to 0.9 ± 0.9 after treatment.

Conclusion: The combination treatment for NVG was found to enable an IOP reduction of 29.9% and prevent a significant reduction in visual acuity in 85% of eyes with NVG.

Author Biographies

  • U. P. Sydorchuk, Danylo Halytsky Lviv National Medical University

    Post-Graduate Student at Ophthalmology Department, Faculty of Post-Graduate Education, Danylo Halytsky Lviv National Medical University and Ophthalmologist at Oculus Medical Center

  • I. Ia. Novytskyy, Danylo Halytsky Lviv National Medical University and Oculus Medical Center

    Dr Sc (Med), Prof. at Ophthalmology Department, Faculty of Post-Graduate Education, Danylo Halytsky Lviv National Medical University and Oculus Medical Center

References

Qiu M, Shukla AG, Sun CQ. Improving Outcomes in Neovascular Glaucoma. Ophthalmol Glaucoma. 2022 Mar-Apr;5(2):125-127. https://doi.org/10.1016/j.ogla.2021.12.001

Tang Y, Shi Y, Fan Z. The mechanism and therapeutic strategies for neovascular glaucoma secondary to diabetic retinopathy. Front Endocrinol (Lausanne). 2023 Jan 23; 14:1102361. https://doi.org/10.3389/fendo.2023.1102361

Dumbrăveanu L, Cușnir V, Bobescu D. A review of neovascular glaucoma. Etiopathogenesis and treatment. Rom J Ophthalmol. 2021 Oct-Dec;65(4):315-329. https://doi.org/10.22336/rjo.2021.66

Al-Halafi AM. Vascular endothelial growth factor trap-eye and trap technology: Aflibercept from bench to bedside. Oman J Ophthalmol. 2014 Sep;7(3):112-5. https://doi.org/10.4103/0974-620X.142591

Vempati P, Popel AS, Mac Gabhann F. Extracellular regulation of VEGF: isoforms, proteolysis, and vascular patterning. Cytokine Growth Factor Rev. 2014 Feb;25(1):1-19. https://doi.org/10.1016/j.cytogfr.2013.11.002

Chen S, Feng J, Ma L, Liu Z, Yuan W. RNA interference technology for anti-VEGF treatment. Expert Opin Drug Deliv. 2014 Sep;11(9):1471-80. https://doi.org/10.1517/17425247.2014.926886

Olmos LC, Lee RK. Medical and surgical treatment of neovascular glaucoma. Int Ophthalmol Clin. 2011 Summer;51(3):27-36. https://doi.org/10.1097/IIO.0b013e31821e5960

Bai L, Wang Y, Liu X, Zheng Y, Wang W, He N, et al. The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma. Front Med (Lausanne). 2022 Jan 10; 8:766032. https://doi.org/10.3389/fmed.2021.766032

Sydorchuk U, Novytskyy I. Efficacy of surgery plus anti-VEGF for the treatment of neovascular glaucoma. J. Оphthalmol. (Ukraine) [Internet]. 2023 Feb. 28 [cited 2024 Jan. 27] ;(1):3-8. Available from: https://ua.ozhurnal.com/index.php/files/article/view/1

Dubey S, Pegu J. Management of Neovascular Glaucoma. Journal of Current Glaucoma Practice. 2009; 3: 27-34. https://doi.org/10.5005/jp-journals-10008-1062

PalfiSalavat MC, Șeclăman EP, Barac R, Ungureanu E, Iorgu G, Artamonov A, et al. The role of Anti-VEGF agents in treatment of neovascular glaucoma. Rom J Ophthalmol. 2022 Jul-Sep;66(3):209-213. https://doi.org/10.22336/rjo.2022.41

Rong AJ, Swaminathan SS, Vanner EA, Parrish RK 2nd. Predictors of neovascular glaucoma in central retinal vein occlusion. Am J Ophthalmol. 2019; 204:62-69. https://doi.org/10.1016/j.ajo.2019.02.038

Sun Y, Liang Y, Zhou P, Wu H, Hou X, Ren Z, et al. Anti-VEGF treatment is the key strategy for neovascular glaucoma management in the short term. BMC Ophthalmol [Internet]. 2016;16(1):1-8. https://doi.org/10.1186/s12886-016-0327-9

Al Rubaie K, Albahlal A, Alzahim T, Edward DP, Kozak I, Khandekar RB. Neovascular Glaucoma Progress and Impact of Therapeutic Intervention in Saudi Arabia. Cureus. 2021 Sep 3;13(9): e17696. https://doi.org/10.7759/cureus.17696

Tsai JC, Shields MB. Neovascular Glaucoma Current Concepts and Management. Glaucoma today. 2006; May/June: 36-42. https://doi.org/10.1007/978-1-59745-047-8_7

Rodrigues I, Kin Sheng Lim. Reversing the Rubeotic Rampage - Current Approaches in the Management of Neovascular Glaucoma. European Ophthalmic Review. 2016;10:19. https://doi.org/10.17925/EOR.2016.10.01.19

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Published

2024-07-02

Issue

No. 3 (2024): Journal of Ophthalmology (Ukraine)

Section

Clinical Ophthalmology

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Copyright (c) 2024 Sydorchuk U. P., Novytskyy I. Ia.

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How to Cite

[1]
2024. Efficacy of a combination of conservative and surgical methods of treatment for neovaascular glaucoma associated with diabetic retinopathy and central or branch retinal vein occlusion. Ukrainian Journal of Ophthalmology . 3 (Jul. 2024), 16–23. DOI:https://doi.org/10.31288/oftalmolzh202431623.

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