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Objective:To investigate the efficacy and prognostic factors of pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR) with chronic renal failure (CRF).Methods:A retrospective study. From January 2016 to June 2021, a total of 82 eyes of 58 patients diagnosed with PDR combined with CRF and treated with PPV in Department of Ophthalmology, The Second Hospital of Hebei Medical University were included in the study. There were 32 cases in males and 26 cases in females. The mean age was (48.45±10.41) years. The course of renal failure was (4.15±3.23) years, and the course of diabetes was (14.45±6.71) years. All patients undergo best-corrected visual acuity (BCVA). The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for recording. The mean number of logMAR BCVA was 2.04±0.82 (0.7-2.8). The duration of vitreous hemorrhage averaged (2.65±1.55) months. There were 38 eyes (46.3%, 38/82) with traction retinal detachment; 32 eyes had a history of panretinal photocoagulation (PRP) treatment (39.0%, 32/82). All eyes were treated with 25G PPV. Patients with traction retinal detachment were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) 3 days before surgery. Opacification of the lens affected the operation operator combined with phacoemulsification. Biochemical indexes such as hemoglobin, glycosylated hemoglobin, albumin, creatinine, uric acid, and alternative treatment (non-dialysis/hemodialysis/peritoneal dialysis) were collected. Postoperative follow-up time was ≥6 months. χ2 test or Fisher's exact test were used for comparison between groups. A logistic regression model was used for multivariate analysis, and Spearman correlation analysis was used to evaluate the correlations between variables. Results:At 6 months after surgery, the mean logMAR BCVA was 1.16±0.57. Compared with logMAR BCVA before surgery, the difference was statistically significant ( t=-0.837, P<0.001); 44 eyes had BCVA ≥0.1 and 38 eyes had BCVA <0.1. Postoperative vitreous hemorrhage (PVH) was observed in 17 eyes after surgery (20.7%, 17/82). PVH occurred in 15 (46.9%, 15/32), 1 (2.3%, 1/44), and 1 (16.7%, 1/6) eyes in patients without dialysis, hemodialysis and peritoneal dialysis, respectively. There was significant difference between those without dialysis and those on hemodialysis ( χ2=26.506, P<0.05). There was no significant difference between peritoneal dialysis patients and those without dialysis and hemodialysis patients ( χ2=2.694, 2.849; P>0.05). PVH occurred in 3 (10.0%, 3/30) and 14 (27.0%, 14/52) eyes of vitreous cavity filled with silicone oil and perfusion fluid, respectively. The difference was statistically significant ( χ2=3.315, P<0.05); 1 (33.3%, 1/3) and 10 (71.4%, 10/14) eyes were treated with PPV again, respectively, and the difference was statistically significant ( P<0.05). Neovascular glaucoma (NVG) occurred in 12 eyes (14.6%, 12/82). Logistic regression analysis showed that age [odds ratio ( OR) =0.911, P<0.05], diabetic retinopathy (DR) stage ( OR=7.229, P<0.05), renal failure duration ( OR=0.850, P<0.05), operation time ( OR=1.135, P<0.05) was an independent risk factor for poor vision prognosis. Diabetes duration ( OR=1.158, P<0.05), renal failure duration ( OR=1.172, P<0.05) and alternative therapy were independent factors affecting the occurrence of PVH. Diabetes duration ( OR=1.138, P<0.05) and renal failure duration ( OR=1.157, P<0.05) were independent risk factors for postoperative NVG. Spearman correlation analysis showed that PVH was strongly correlated with post-operative NVG ( r=0.469, P<0.01). There was no significant correlation between blood glucose, hemoglobin, creatinine and blood urea nitrogen and prognosis of postoperative vision, PVH and NVG occurrence ( P>0.05). Conclusions:In PDR patients with CRF, DR Stage, age, renal failure course and operation duration are correlated with vision prognosis. Compared with those who do not receive alternative therapy, hemodialysis treatment can reduce the occurrence of PVH and NVG after surgery.
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AIM: To investigate the risk factors associated with neovascular glaucoma(NVG)after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).METHODS: The PDR patients who received 23G PPV treatment at Shenyang He Eye Specialist Hospital from October 2015 to September 2020 and were followed up for at least 12mo with complete data were retrospectively collected. The patients were divided into two groups according to the occurrence of NVG during follow-up. The preoperative and intraoperative variables between two groups were compared. The cumulative hazard ratio for NVG was evaluated. RESULTS: A total of 151 PDR patients(169 eyes)with a mean follow-up of 18.07±12.55(1～79)mo were included, of which 30(17.8%)eyes developed NVG, the mean time of occurrence was 6.27±4.01(1～17)mo, and 50%(15 eyes)of NVG occurred within 5mo after vitrectomy. The cumulative hazard ratios of NVG at postoperative 3, 6 and 12mo were 4.8%, 12.6% and 18.1%, respectively. Multivariate logistic regression analysis showed that preoperative best corrected visual acuity(OR=3.077, 95%CI: 1.203～7.869, P=0.019), preoperative iris rubeosis(OR=7.897, 95%CI: 1.313～47.498, P=0.024), and contralateral NVG(OR=22.108, 95%CI: 1.562～312.861, P=0.022)were risk factors with the occurrence of NVG, while the number of intraoperative retinal laser photocoagulation(OR=0.772, 95%CI: 0.666～0.893, P=0.001)was the protective factor with the occurrence of NVG.CONCLUSIONS: The incidence of NVG in PDR eyes after PPV was 17.8%, of which 50% occurred within 5mo after surgery. PDR eyes with poor baseline visual acuity, iris rubeosis, and contralateral NVG are prone to postoperative NVG, and sufficient intraoperative retinal laser photocoagulation has a certain protective effect. PDR eyes after PPV should be closely followed up for 1a.
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AIM: To investigate the clinical efficacy and safety of ultrasonic ciliary plasty(UCP)combined with injection of anti-vascular endothelial growth factor(VEGF)in the treatment of neovascular glaucoma(NVG).METHODS: A total of 30 NVG patients(30 eyes)admitted to the First Affiliated Hospital of Bengbu Medical College from September 2020 to September 2021 were selected. After admission, all the eyes of the patients were injected with anti-VEGF drug(ranibizumab). After surgery, 15 patients were randomly selected for UCP treatment(UCP group), and the other 15 patients received trabeculectomy(trabeculectomy group). During the 10mo postoperative follow-up, the decrease of intraocular pressure was compared between the two groups and the changes of the degree of ocular pain and the occurrence of related complications were evaluated at each follow-up visit.RESULTS: The intraocular pressure and pain degree of the UCP and trabeculectomy groups were significantly lower than those before operation, and the complication probability of the UCP group was less than that of the trabeculectomy group.CONCLUSION: With fewer complications and high safety, UCP combined with anti-VEGF injection can effectively control intraocular pressure and pain in NVG patients.
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Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single?center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ?6 months of follow?up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 � 0.8 vs. 1.9 � 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.
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@#AIM: To evaluate the effect and safety of conbercept combined with trabeculectomy and retinal photocoagulation in the treatment of nevoascular glaucoma.<p>METHODS: A retrospectively analysis study. The clinical data of 47 patients(47 eyes)with neovascular glaucoma admitted to Shaanxi Eye hospital from January 2018 to December 2020. The patients were followed up for 6mo to observe the changes of visual acuity and intraocular pressure and the occurrence of complications before and after treatment.<p>RESULTS: At 6mo after compound trabeculectomy, the visual acuity of this group of patients improved in 25 eyes(53%), among which 8 eyes without light perception before operation, visual acuity increased to 0.2 and 0.02 respectively, to hand motion/30cm in 2 eyes,restoring light perception from no light perception 2 eyes; The visual acuity remained unchanged in 19 eyes(40%)and decreased in 3 eyes(6%). 40 eyes of 40 cases did not use any intraocular pressure lowering drugs, the intraocular pressure <21mmHg and the complete success rate was 85% at the 6mo follow up post-operatively. The intraocular pressures were 15.6±6.2, 12.8±5.9, 14.7±5.3, 17.1±6.9, 18.3±6.7mmHg at 1, 7d, 1, 3 and 6mo after compound trabeculectomy, which were different from the intraocular pressure at admission(46.0±11.9mmHg)and intravitreal intraocular pressure(39.9±12.5mmHg)after 3d of intravitreal injection of conbercept were significantly different(<i>F</i>=106.65, <i>P</i><0.001). Hyphema occurred in 3 eyes after compound trabeculectomy, and completely absorbed within 3-7d after conservative drug treatment.<p>CONCLUSION: Intravitreal injection of conbercept combined with compound trabeculectomy and retinal photocoagulation is safe and effective in the treatment of neovascular glaucoma.
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@#AIM: To observe the clinical therapeutic efficacy of Ahmed glaucoma valve(AGV)implantation with intravitreal injection of aflibercept or ranibizumab in patients with neovascular glaucoma(NVG). <p>METHODS: A retrospective study. The clinical data of 33 cases(33 eyes)with NVG angle-closure glaucoma who were received intravitreal injection of aflibercept or ranibizumab with AGV implantation from January 2018 to August 2020 in our hospital were involved in this study. There were 18 eyes in the aflibercept group and 15 eyes in the ranibizumab group. All patients were followed-up for 6mo. The best-corrected visual acuity(BCVA), intraocular pressure, neovascularization, and postoperative complications were recorded and evaluated.<p>RESULTS: Before the first intravitreal injection and 1wk after intravitreal injection, the differences of intraocular pressure and BCVA in two groups were not statistically significant(<i>P</i>>0.05); The changes of intraocular pressure and BCVA before the first intravitreal injection and after AGV implant 1wk, 1, 3, 6mo were statistically significant in two groups(<i>P</i><0.01), but there were no statistically significant differences intraocular pressure and BCVA between the two groups at each follow-up time point(<i>P</i>>0.05). There were no significant differences in average number of injections between aflibercept group(1.61±0.98)and ranibizumab group(1.80±0.86)(<i>P</i>>0.05). The differences of neovascular recurrence rate, incidence of early and late complications and surgical success rates were not statistically significant(<i>P</i>>0.05).<p>CONCLUSION: Intravitreal aflibercept or ranibizumab injection combined with AGV implantation is an effective treatment for NVG. The clinical efficacy of aflibercept and ranibizumab were similar.
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@#AIM: To investigate the therapeutic effect of conbercept injection combined with Ahmed valve implantation and phacoemulsification in the treatment of neovascular glaucoma(NVG).<p>METHODS: Retrospective analysis. Totally 18 patients(18 eyes)with NVG complicated combined with cataract in our hospital from June 2018 to January 2020. All patients received intraocular injection of conbercept at 3-7d before surgery, Ahmed valve implantation and phacoemulsification were performed after meeting the surgical indications. Best corrected visual acuity(BCVA), intraocular pressure(IOP), resolution of iris neovascularization and postoperative complications were followed up after the surgery, and all the cases were followed up 12mo. <p>RESULTS: Compared with preoperation(51.44±8.18 mmHg), IOP was significant decreased at 1, 7d, 1, 3, 6mo, 1a after surgery(25.94±11.82, 15.39±4.97, 15.94±2.69, 15.33±4.54, 18.89±7.95, 16.27±5.22 mmHg)(<i>P</i><0.05). Last follow up after surgery, BCVA was improved in 12 eyes(67%), unchanged in 5 eyes(28%)and decreased in one eye. At 1a after operation, the complete success rate was 83%(15 eyes), conditional success rate was 11%(2 eyes), one eye of losing control of IOP was failed. <p>CONCLUSION: Conbercept intraocular injection combined with Ahmed valve implantation and phacoemulsification can not only effectively control postoperative IOP, but also improve the visual acuity of the patients as much as possible. It is an effective method for the treatment of NVG with cataract.
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@#AIM: To investigate the risk factors of neovascular glaucoma(NVG)after central retinal vein occlusion(CRVO), and to construct a predictive model.<p>METHODS: The clinical data of 483 patients(527 eyes)with CRVO admitted to the Department of Ophthalmology of our hospital from February 2016 to March 2020 were retrospectively selected and followed up until June 2021. CRVO combined with NVG were counted.The risk prediction model of NVG after CRVO was constructed according to the regression coefficient of risk factors, and the Hosmer-Lemeshow(<i>H-L</i>)test and receiver operating characteristic(ROC)curve method were used to evaluate the prediction model.<p>RESULTS: Fifteen patients(23 eyes)were followed up with 35(15-64)mo. NVG was happened in 70 patients(86 eyes)(NVG group)and no NVG was happened in 398 patients(418 eyes)(non-NVG group). Regression analysis showed that ischemic CRVO, IOP≥18mmHg at the first visit, hypertension,relative afferent pupillary defect(RAPD)≥0.75logU at the first visit, uncorrected visual acuity(UCVA)>0.30(LogMAR)at the first visit were risk factors for NVG after CRVO(<i>P</i><0.01), and anti-vascular endothelial growth factor(VEGF)therapy were protective factors for NVG after CRVO(<i>P</i><0.01). The risk prediction model for NVG after CRVO had good consistency(<i>H-L</i> test <i>P</i>>0.05)and discrimination(area under the curve was 0.877, 95%<i>CI</i>:0.830-0.924, sensitivity was 84.3%, specificity was 88.9%). The predictive scoring model was further constructed, and the critical value of NVG after CRVO was 5 points,the area under the curve was 0.844(95%<i>CI</i>:0.790-0.898), sensitivity was 78.6%, and specificity was 87.4%.<p>CONCLUSION: Ischemic CRVO, IOP≥18mmHg at the first visit,hypertension,RAPD≥0.75logU at the first visit, UCVA>0.30(LogMAR), and anti-VEGF therapy are closely related to NVG after CRVO, and the predictive model established on this basis has good predictive efficacy.
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@#AIM: To compare the safety and effectiveness of pars plane filtering(PPF)and trabeculectomy(TRA)on neovascular glaucoma(NVG). <p>METHODS: This retrospective comparison was done in 12 patients(one eye with NVG in each)who were treated with PPF surgery and 15 patients who were treated during the same period with TRA, one eye was treated in each patient. Intraocular pressure(IOP), complete surgical success rate, peripheral anterior chamber depth(PACD), postoperative anterior chamber morphology, visual acuity and complications were observed and compared between the two groups.<p>RESULTS: The IOP was significantly reduced at each time point after the surgery 1, 3d, 1wk, 1, 3mo after operation(P<0.05), and there was no significant between-group difference at any time point(P >0.05). The rate of complete success observed 3mo after operation was superior in PPF group(92% vs 53%, P<0.05). PACD was found to be deeper at 1wk after the operation in PPF group as compared with the values before the operation and was deeper than that in TRA group(P<0.05); while this comparison in TRA group showed no significant change(P>0.05). After the operation, the anterior chamber angle was open and the anterior chamber was deepened in PPF group. No significant changes in visual acuity before and after the operation within each group and between groups were observed 3mo after the surgery(P>0.05). The incidence of postoperative hemorrhage in anterior chamber was lower in PPF group(8% vs 47%, P<0.05). <p>CONCLUSION: Both PPF and TRA surgery can successfully control IOP of NVG. However, PPF surgery appeared to be superior as having a higher complete success rate. In addition, PPF surgery makes the anterior chamber deeper and wider, and result in fewer severe postoperative complications.
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Conbercept is a novel anti-vascular endothelial growth factor drug independently developed by China. Since it was approved for clinical application by the State Food and Drug Administration of China in 2013, conbercept has shown reliable safety and efficacy in the treatment of ocular neovascular diseases such as wet age-related macular degeneration, choroidal neovascularization and macular edema. For different diseases, the treatment strategies of conbercept are different. This article mainly reviews the application progress of conbercept in ocular neovascularization related diseases including wet age-related macular degeneration, diabetic macular edema, pathologic myopia choroidal neovascularization, neovascular glaucoma, retinopathy of prematurity and corneal neovascularization, and summarizes and explores the indications, administration scheme and therapeutic effect of conbercept. It is expected that the indications of conbercept will be wider and the administration scheme will be more given, and the usage of conbercept will bring new ideas for the treatment of ocular neovascular diseases.
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@#AIM: To evaluate the efficacy and safety of preoperative intravitreal injection of ranibizumab(IVR)and panretinal photocoagulation(PRP)combined with conventional trabeculectomy without drainage device in patients with neovascular glaucoma(NVG).<p>METHODS: The charts of 27 patients(27 eyes)who presented with NVG in our hospital between August 2015 and November 2018 were reviewed. All eyes were treated using the standard protocol of IVR accompanied by PRP, followed by conventional trabeculectomy without drainage device. The main outcomes were intraocular pressure(IOP)control, change in best-corrected visual acuity(BCVA), and surgical complications.<p>RESULTS: The postoperative follow-up periods for all patients were at least 18(mean 21.7±4.3)mo. The IOP significantly decreased from 45.7±5.1 mmHg(baseline)to 18.4±3.6 mmHg(last visit), and BCVA(LogMAR)improved from 2.42±0.68(baseline)to 1.77±0.93(last visit). The success rate was higher in eyes with peripheral anterior synechiae(PAS)≤50% than in those with PAS >50% after 3mo postoperatively. The main surgical complications were hyphema(11.1%)and hypotony with a shallow anterior chamber(14.8%)during the early postoperative stage, along with encapsulated bleb(37.0%)during the mid-late postoperative stage. Serious intraoperative or postoperative complications were not observed.<p>CONCLUSION: IVR and PRP combined with conventional trabeculectomy without drainage device is a safe and effective way in NVG treatment, especially for eyes with PAS ≤50%. Preoperative IVR and PRP appear to improve the success rate.
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Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.
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@#AIM:To assess the efficacy of Ahmed glaucoma valve implantation combined with lens extraction for neovascular glaucoma(NVG)with cataract.<p>METHODS: A retrospective comparative study was designed. 93 patients with NVG were enrolled. All patients received preoperative anti-vascular endothelial growth factor(VEGF)injections, 41 eyes underwent Ahmed glaucoma valve(AGV)implantation only, and 52 eyes underwent AGV implantation and lens extraction by phacoemusification. The best corrected visual acuities(BCVA), intraocular pressure(IOP), and surgical complications were evaluated.<p>RESULTS: Postoperative visual acuity was improved in 16 eyes(39%), decreased in 14 eyes(34%), unchanged in 11 eyes(27%)in group 2, and 15 eyes(29%)improved,24 eyes(46%)decreased, 13 eyes(25%)unchanged in group 1 respectively(<i>P</i>>0.05). The group 2 demonstrated an 51% complete and 22% qualified success rate and 27% failure rate, and the 44% complete and 25% qualified success rate and 31% failure rate in group 1(<i>P</i>>0.05). Among the complications, fibrous exudation(56%)was the first, hyphema(46%)came second in group 2, while shallow anterior chamber(35%)was the most, fibrous exudations(31%)and anterior chamber hyphema(25%)followed in the group 1. And no tube extrusion serious complication had occurred in both groups(<i>P</i><0.05). No significant differences in postoperative complications were observed between the groups(<i>P</i>>0.05).<p>CONCLUSION: For NVG with cataract, AGV implantation with lens extraction is a priority for reduction of IOP and improvement of visual acuity.
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@#AIM: To investigate the impact of intravitreal conbercept injection on the aqueous humor levels of vascular endothelial growth factor(VEGF), interleukin-6(IL-6)and interleukin-8(IL-8)in patients diagnosed with neovascular glaucoma(NVG), and to evaluate the efficacy of conbercept in combination with different surgical modalities.<p>METHODS: This study was conducted as a retrospective, case series investigation. A total of 102 patients(102 eyes)diagnosed with NVG from Jan. 2019 to Feb. 2020 were enrolled and randomized to trabeculectomy group(50 eyes of 50 cases)or EX-PRESS drain implantation group(52 eyes of 52 cases)3-5d after conbercept injections. The concentrations of VEGF, IL-6 and IL-8 in aqueous humor were determined by enzyme-linked immunosorbent assay(ELISA). The therapeutic efficacies of different surgical modalities were evaluated and compared by status of iris neovascularization, changes in postoperative intraocular pressure(IOP), improvement of visual acuity and incidence of complications.<p>RESULTS:Decreases in aqueous humor concentrations of VEGF, IL-6 and IL-8 were observed at 3-5d after treatment of conbercept(all <i>P</i><0.05). At 1, 3d, 1, 3, 6 and 12mo after surgery, the IOP levels of patients in both groups were significantly reduced compared to those before surgery(all <i>P</i><0.05), and there was a statistically significant difference in IOP between the two groups at 3, 6, and 12mo postoperatively(all <i>P</i><0.05). At 6 and 12mo after surgery, patients treated with EX-PRESS drain implantation showed better visual acuity compared to patients treated with trabeculectomy(all <i>P</i><0.05). There was no statistically significant difference in types and dosages of anti-glaucoma drugs administered to patients in different groups. At 12mo follow-up, success rate of surgery in the EX-PRESS drain implantation group(86.5%)was higher than that in the trabeculectomy group(70.0%), along with remarkably lower incidence rate of complications compared to that of the trabeculectomy group(<i>P</i><0.05).<p>CONCLUSION: The intravitreal injection of conbercept could down-regulate aqueous humor concentrations of VEGF, IL-6 and IL-8. Both of trabeculectomy and EX-PRESS drain implantation could reduce IOP in NVG patients, but the latter procedure had fewer incidence of complications and was more advantageous in improving visual acuity.
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@#AIM: To investigate the effect of conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation for neovascular glaucoma(NVG)with and without vitreous hemorrhage.<p>METHODS: In this retrospective study, 39 eyes in 37 patients who were diagnosed with NVG with and without vitreous hemorrhage(where iridotrabecular contact is more than 180°)in the ophthalmology department of Xi'an No.1 Hospital between January 2016 and December 2017 were enrolled in this study. Patients were divided into two groups, based on whether they had vitreous hemorrhage. All patients received 0.5 mg(0.05 mL)conbercept intravitreal injection. Twenty-one eyes in 20 patiants(Group 1)without vitreous hemorrhage received EX-PRESS(P50)glaucoma drainage device implantation on 4d after conbercept intravitreal injection and then received panretinal photocoagulation 2wk after implantation. Eighteen eyes in 17 patients(Group 2)with vitreous hemorrhage received vitrectomy combined with the EX-PRESS(P50)glaucoma drainage device implantation and panretinal photocoagulation on 4d after conbercept intravitreal injection. Air or silicone oil was selectively filled according to the situation during the operation. All patients were followed up for 6mo after operation.<p>RESULTS: No statistical difference was found between preoperative best corrected visual acuity(BCVA)and postoperative(6mo)BCVA in Group 1(<i>P</i>>0.05). There was statistical difference between preoperative BCVA and postoperative(6mo)BCVA in Group 2(<i>P</i><0.05). The intraocular pressure( IOP)of Group 1 at postoperative 1d, 1wk, 1, 3 and 6mo was 20.5±4.3 mmHg, 19.6±3.8 mmHg, 20.1±3.7 mmHg, 19.9±4.2 mmHg, and 19.3±2.9 mmHg, respectively. The postoperative IOP of Group 2 was 22.3±3.7 mmHg, 20.6±2.8 mmHg, 20.4±3.8 mmHg, 18.9±4.1 mmHg, and 19.3±3.4 mmHg, respectively. The postoperative IOP of every time point was significantly lower than the preoperative IOP in Group 1 and Group 2(<i>P</i><0.05). During the follow up, three eyes in three patients showed a recurrence of iris neovascularization and were given one more 0.05 mL conbercept intravitreal injection. <p>CONCLUSION: Conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation can effectively reduce IOP in NVG(where the iridotrabecular touch is more than 180°).
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PURPOSE: To report a case of neovascular glaucoma after intraocular lens iris fixation, in which the neovascularization of the iris and the anterior chamber improved with only intraocular pressure (IOP) lowering agents, without treatment of the underlying cause.CASE SUMMARY: A 74-year-old woman who had undergone bilateral cataract surgery presented with left ocular pain and headache that started 3 days previously. At the initial examination, the best-corrected visual acuity was 0.9, and the IOP was 38 mmHg in the left eye. Slit-lamp examination of the left eye revealed diffuse iris neovascularization and several polypropylene suture knots fixated in the superior and inferior iris. Gonioscopic examination revealed angle neovascularization in all quadrants, with focal peripheral anterior synechia in the inferior quadrant. Fundus examination presented inferior neuroretinal rim thinning and an inferior retinal nerve fiber layer defect in the left eye. Fluorescent angiography showed no ischemic retinal lesions, with the exception of several retinal microaneurysms. Six months after topical IOP-lowering treatment in the left eye, the IOP was 10 mmHg, and neovascularization of the iris and angle had regressed completely.CONCLUSIONS: In the case of early-stage neovascular glaucoma with partial angle closure not associated with retinal ischemia, IOP-lowering treatment can be effective without other invasive procedures.
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@#AIM: To observe the effects of combined anti-VEGF therapy on neovascular glaucoma.<p>METHODS: A total of 62 patients(68 eyes)with neovascular glaucoma admitted to our hospital from February 2012 to October 2018 were retrospectively analyzed. Group A were given intravitreal injection of anti-VEGF drug(conbercept ophthalmic injection)0.05mL, and complex trabeculectomy was performed 1wk after injection, and total retinal laser photocoagulation was performed 3wk after injection. Cyclocryosurgery was performed in group B. Intraocular pressure(IOP), best corrected visual acuity(BCVA), axial length and postoperative complications of patients in two groups were observed before treatment and 2wk, 1mo, 3mo and 6mo after treatment. <p>RESULTS: The regression degree of iris neocescularization in group A was significantly better than that in group B. IOP at 2wk, 1mo, 3mo and 6mo after surgery in the two groups showed statistical differences(<i>P</i><0.05). There was a statistically significant difference in axial length 6mo after treatment(<i>P</i><0.05). The total effective rate was 94% in anti-VEGF group(group A)and 78% in cyclocryosurgery group(group B), the difference was not statistically significant(<i>P</i>=0.073).<p>CONCLUSION: It is safe and effective for the combined treatment of anti-VEGF drug, combined trabeculectomy and total retinal laser photocoagulation in the treatment of neovascularization glaucoma.
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@#AIM: To investigate the effect of modified Ahmed drainage valve implantation combined conbercept in the treatment of neovascular glaucoma.<p>METHODS: Neovascular glaucoma patients(59 cases, 60 eyes)were separated into experiment group(20 cases, 21 eyes)and control group(39 cases, 39 eyes)in our hospital from 2015 to 2018. Patients in the experiment group received Ahmed drainage valve implantation and intravitreal conbercept injection while patients in the control group were treated with ciliarybody photocoagulation. The visual acuity, intraocular pressure and iris neovessels were observed in 3mo after operation.<p>RESULTS: There was no significantly difference in the preoperative data between the two groups and both of them can decrease intraocular pressure(<i>P</i><0.05). The intraocular pressure of experiment group was significantly lower than that of control group in 1wk, 1mo and 3mo after treatment(all <i>P</i><0.05). The iris neovessels disappeared in experiment group, which was significantly different from that in control group(<i>Z</i>=2.74,<i>P</i><0.05). <p>CONCLUSION: Modified Ahmed drainage valve implantation combined with intravitreal conbercept injection can effectively decrease the intraocular pressure for a long time and make the iris neovessels vanish.
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@#AIM: To quantitatively measure and evaluate the VEGF-A, platelet derived growth factor(PDGF)and pigment epithelium derired factor(PEDF)in the aqueous humor of patients with neovascular glaucoma(NVG). <p>METHODS: Prospectively clinical study. This study involved 23 eyes of 23 patients with advanced NVG and 23 control subjects with age related cataract. Protein concentrations of VEGF-A, PDGF and PEDF in aqueous humor and plasma were determined by enzyme-linked immunosorbent assay(ELISA)tests. <p>RESULTS: The VEGF-A and PDGF concentrations in aqueous humor from NVG patients were(1130.56±69.32)ng/L and(221.95±56.08)ng/L, respectively. Both of them were significantly higher than control subject(226.45±37.46)ng/L,(36.25±7.12)ng/L(<i>P</i><0.01). Aqueous PEDF was significantly lower in the NVG group(195.69±42.00)ng/L than that in controls(497.89±12.52)ng/L(<i>P</i><0.01). However, levels of VEGF-A, PDGF and PEDF in the serum of NVG were(226.45±37.46)ng/L,(29.57±6.31)ng/L and(13.24±1.76)ng/L, respectively, which were similar with control subjects(219±34.89)ng/L,(28.28±7.24)ng/L and(12.96±2.08)ng/L(<i>P</i>>0.05). The concentrations of VEGF-A were closely positive correlated with levels of PDGF in the aqueous humor of patients with NVG(<i>r</i>=0.502, <i>P</i>=0.015). However, the concentrations of VEGF-A were closely negative correlated with levels of PEDF in the aqueous humor of patients with NVG(<i>r</i>=-0.480, <i>P</i>=0.020). <p>CONCLUSION: There were higher levels of VEGF-A and PDGF, and lower level of PEDF in the aqueous humor of patients with NVG. There was a positive correlation between VEGF-A and PDGF, a negative correlation between VEGF-A and PEDF. The combination of anti-VEGF agent, PDGF inhibitor and PEDF may provide a new idea for the treatment of NVG.