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

How to Cite

1.
Sydorchuk UP, Novytskyy II. 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. J.ophthalmol. (Ukraine) [Internet]. 2024 Jul. 2 [cited 2024 Nov. 28];(3):16-23. Available from: https://ua.ozhurnal.com/index.php/files/article/view/139

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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