Combined vitrectomy, near-confluent endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma

Abstract

AbstractPurposeEvaluated the safety and efficacy of an integrative surgical approach to neovascular glaucoma (NVG).MethodsConsecutive interventional case series of NVG with one-year follow-up. Eyes underwent pars plana vitrectomy, near-confluent panretinal photocoagulation, intravitreal bevacizumab, and transscleral cyclophotocoagulation. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), glaucoma medication score (GMS), visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6 and 12 months. Blind eyes were excluded.Results83 eyes of 83 patients (53 male, 30 female, mean age 74.6±11.6 years) were included and 53 completed a one-year follow-up. NVG underlying conditions included retinal vein occlusion (n=41), proliferative diabetic retinopathy (n=25), central retinal artery occlusion (n=10), and ocular ischemic syndrome (n=6). Mean IOP decreased postoperatively from 46.0±10.3 mmHg to 14.2±8.9 mmHg (p<0.001), GMS from 4.8 to 1.8 (p<0.001) and VAPS from 6 to 0. BCVA was unchanged. All postoperative complications had resolved at 1 month postop. 26 eyes did not require additional surgical treatment during follow-up.ConclusionsA single, comprehensive surgery session was able to significantly lower IOP, reduce GMS and control pain.