Efficacy of Ahmed Glaucoma Valve Implantation on Neovascular Glaucoma

A Novel Scleral Tunnel Technique for the Prevention of Ahmed Glaucoma Valve Tube Exposure

Tube exposure after Ahmed glaucoma valve (AGV) implantation is a serious complication in eyes with glaucoma. This study aimed to present an effective and minimally invasive scleral tunnel technique for preventing tube exposure. A scleral tunnel was created using a 22-gauge needle between two scleral incisions. The scleral incisions were made 2 mm and 8 mm from the limbus for a simple AVG implantation, and 4 mm and 8 mm from the limbus for an AVG implantation performed together with pars plana vitrectomy (PPV), in which a trocar for the PPV was inserted through the scleral incision at the 4 mm position. After trimming the tube to an appropriate length, it was inserted into the scleral tunnel created by the 22-gauge needle. The tube was then removed from the sclera, and its tip was inserted into the posterior chamber through the scleral incision. After confirming the insertion of the tube into the posterior chamber, the Tenon's capsule and conjunctiva were sutured using 8-0 Vicryl sutures. No postoperative complications, including tube exposure, were observed. This novel technique is an effective and minimally invasive method for preventing tube exposure after AGV implantation.

Impact of mitomycin C on surgical outcomes of PAUL glaucoma implant in neovascular glaucoma: 12-month follow-up results

PURPOSE

To evaluate the effectiveness of the PAUL Glaucoma Implant (PGI) and the adjunctive impact of intraoperative Mitomycin C (MMC) on surgical outcomes in patients with neovascular glaucoma (NVG).

METHODS

This retrospective, comparative study included NVG patients who underwent PGI implantation. The cohort was divided into two groups: Group 1 (PGI without MMC) and Group 2 (PGI with MMC). Inclusion criteria encompassed a minimum 12-month postoperative follow-up and preoperative light perception. Surgical success was defined as maintaining intraocular pressure (IOP) between 6-21 mmHg without additional surgical intervention from the third month to the end of the 12-month follow-up. Failure due to hypotony was defined as an IOP ≤5 mmHg.

RESULTS

The study enrolled a total of eighty-one patients, with 40 patients in Group 1 and 41 in Group 2. There were no significant differences in the demographic data and baseline ocular characteristics between the groups. Group 1 required more medications at 1, 3, 6, and 12 months (p < 0.05 for all). Surgical success rates at 12 months were 85% for Group 1 and 87.8% for Group 2, with no statistically significant difference between the groups (p = 0.140). Group 2 demonstrated a lower frequency of additional glaucoma procedures (p = 0.003) and delayed ripcord suture removal (p = 0.0001).

CONCLUSIONS

Incorporating MMC as an adjunct to PGI implantation may improve IOP control and decrease the requirement for additional medications and surgical interventions in NVG patients. However, there was no statistically significant difference between the two groups in terms of the surgical success criterion.

Initial Clinical Experience with Ahmed Valve in Romania: Five-Year Patient Follow-Up and Outcomes

BACKGROUND

Glaucoma is a leading cause of irreversible blindness worldwide and is particularly challenging to treat in its refractory forms. The Ahmed valve offers a potential solution for these difficult cases. This research aims to assess the initial clinical experience with Ahmed valve implantation in Romania, evaluating its effectiveness, associated complications, and overall patient outcomes over a five-year period.

METHODS

We conducted a prospective study on 50 patients who underwent Ahmed valve implantation due to various types of glaucoma. Patients were monitored at several intervals, up to five years post-surgery. Intraocular pressure and visual acuity were the primary measures of success.

RESULTS

On average, patients maintained the intraocular pressure within the targeted range, with the mean intraocular pressure being 17 mmHg 5 years post-surgery. Success, defined as maintaining target intraocular pressure without additional surgery, was achieved in 82% at 1 year, 68% at 3 years, and 60% after 5 years postoperative.

CONCLUSION

Ahmed valve implantation is a viable treatment option for refractory glaucoma, demonstrating significant intraocular pressure reduction and manageable complication rates over a five-year follow-up period. Future research should focus on long-term outcomes and optimization of surgical techniques to further reduce complication rates and improve patient quality of life.

The efficacy and safety of anti-vascular endothelial growth factor combined with Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma: a systematic review and meta-analysis

Background

The intraocular injections of anti-vascular endothelial growth factor (anti-VEGF) demonstrates significant efficacy in inhibiting the formation of ocular neovascularization in neovascular glaucoma (NVG). Ahmed glaucoma valve implantation (AGVI) is extensively employed for the management of diverse glaucoma types.

Objective

To further evaluate the efficacy and safety of anti-VEGF combined with AGVI in the treatment of neovascular glaucoma.

Methods

A thorough search for randomized controlled trials (RCTs) was conducted across eight databases: PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed, and VIP. The search period was set from the inception of each database until March 2, 2024, to identify RCTs investigating the effectiveness and safety of combining AGVI with anti-VEGF therapy for NVG. We used the Cochrane Risk of Bias Assessment Tool to evaluate the quality of the literature and performed statistical analysis using Stata 15.0 software.

Results

Fourteen RCTs were included in this study. Compared with AGVI alone, the combination of anti-VEGF drugs and AGVI can reduce postoperative intraocular pressure (IOP) at 1 week [WMD = -4.03, 95% CI (-5.73, -2.34), p < 0.001], 1 month [WMD = -5.39, 95% CI (-7.05, -3.74), p < 0.001], 3 months [WMD = -6.59, 95% CI (-7.85, -5.32), p < 0.001], 6 months [WMD = -4.99, 95% CI (-9.56, -0.43), p = 0.032], and more than 12 months [WMD = -3.86, 95% CI (-6.82, -0.90), p = 0.011], with a higher Effective rate [RR = 1.27, 95% CI (1.18, 1.37), p < 0.001], decreased incidence of postoperative hyphema [RR = 0.24, 95% CI (0.15, 0.39), p < 0.001], reduced use of postoperative antiglaucoma medications [WMD = -0.48, 95% CI (-0.61, -0.35), p < 0.001], and decreased aqueous humor VEGF levels [SMD = -2.84, 95% CI (-4.37, -1.31), p < 0.001].

Conclusion

In comparison to AGVI alone, the combination of AGVI with anti-VEGF therapy has better effects in reducing IOP at various time intervals, diminishing postoperative antiglaucoma medication requirements and reducing aqueous humor VEGF levels. Furthermore, it effectively minimizes the incidence of postoperative hyphema. Nevertheless, due to the variability in the quality of the trials included, further high-quality experiments will be required in the future to substantiate this conclusion.

Systematic review registration

PROSPERO, identifier CRD42024519862, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024519862.

Factors Affecting the Results of Ahmed Glaucoma Valve Implantation in Diabetic Neovascular Glaucoma With or Without Previous Pars Plana Vitrectomy

Objectives

The aim of this study was to compare the outcomes of Ahmed glaucoma valve implantation (AGVI) in neovascular glaucoma (NVG) due to proliferative diabetic retinopathy (PDR) with or without a pars plana vitrectomy (PPV) history and to analyze the factors affecting surgical failure.

Methods

Patients with NVG secondary to PDR undergoing AGVI at a single center were reviewed retrospectively. The surgical failure rates and post-operative complications were compared between eyes with (PPV-AGVI group) and without previous PPV (AGVI group). Failure was defined as loss of light perception or intraocular pressure (IOP) >17 mmHg despite maximum medication, or need of additional intervention for IOP control or for the management of complications. Survival analysis was investigated by Kaplan-Meier test. The possible factors for failure were analyzed with logistic regression analysis.

Results

The failure rates were 21.9% during the mean follow-up of 27.56±15.38 months and 14.3% during 23.63±12.38 months, in PPV-AGVI group (n=32) and in AGVI group (n=49), respectively (p=0.37). The frequency of complications and surgical intervention need for management of post-operative complications was similar between groups (p>0.05). There was no significant difference in survival analysis (p=0.13). The history of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection before AGVI was significantly associated with failure (odds ratio = 26.941, p=0.02).

Conclusion

The results of AGVI performed with long scleral tunnel technique were comparable in terms of failure rates, between NVG patients with and without previous diabetic vitrectomy. The only significant factor for failure was intravitreal anti-VEGF pre-treatment. This may be related to the necessity of anti-VEGF therapy in aggressive PDR, and also, anti-VEGF agents may increase fibrosis in the anterior chamber angle.

The Relationship between Serous Choroidal Detachment and the Ahmed Glaucoma Valve Failure

Purpose

To investigate the effect of serous choroidal detachment (SCD) on the success of Ahmed glaucoma valve (AGV) implantation.

Methods

Patients who underwent AGV implantation and developed SCD were included in the case group. The control group was matched based on age, sex, baseline intraocular pressure (IOP), glaucoma type, and the number of glaucoma medications. The patient data were retrospectively extracted from available records. The primary outcome measure was an AGV success rate based on 5 < IOP <18 and a 20% reduction from baseline.

Results

Seventeen patients were enrolled in the case group and 38 in the control group. Preoperative visual acuity of patients was 1.17 ± 0.43 and 1.16 ± 0.37 logMAR in the case and control groups, respectively. The patients in the case group showed higher mean IOP at all time intervals compared to controls. However, the mean IOP only reached a statistically significant difference at 3 months (17.94 ± 6.78 mmHg vs. 13.39 ± 3.09 mmHg, P = 0.003). The mean survival duration was significantly shorter in patients with SCD (10.4 ± 0.7 months vs. 11.7 ± 0.2 months for controls log-rank = 4.1, P = 0.04). The cumulative probability of success was 76.5% in patients with SCD and 94.7% in the control group after 12 months.

Conclusions

SCD after AGV implantation could be a risk factor for failure. A larger prospective study with a longer follow-up duration is required to confirm the present study results.

Short- to intermediate-term surgical outcome of Keiki Mehta valve implantation in refractory glaucoma

BACKGROUND

Keiki Mehta body pressure (BP) valve is a glaucoma drainage device that works on the simple mechanism of body pressure.

PURPOSE

To evaluate the short- to intermediate-term efficacy and safety of Keiki Mehta valve implantation in treating refractory glaucoma.

METHODS

This was a prospective, interventional, institution-based study. Adult patients (age >18 years) having refractory glaucoma who underwent Keiki Mehta valve implantation from May 2019 to December 2019 in a tertiary hospital in eastern India were followed up to 18 months.

RESULTS

Twenty patients (20 eyes) with refractory glaucoma who underwent Keiki Mehta valve implantation were followed up on postoperative day 1 and at 1, 3, 6, 12, and 18 months postoperatively. Visual acuity, intraocular pressure (IOP), antiglaucoma medications, and success rate were measured at every visit. There was significant reduction in mean IOP from the preoperative values at every postoperative follow-up ( P < 0.05). Kaplan-Meier survival analysis demonstrated a probability of 50% complete success and 20% qualified success at 18 months. Hypotony was the most common postoperative complication.

CONCLUSION

Keiki Mehta valve implantation is an effective and safe treatment for refractory glaucoma.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma

PURPOSE

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG).

METHODS

The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18 mmHg, and (3) IOP ≤ 15 mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery.

RESULTS

The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4 mmHg and 32.3 ± 8.4 mmHg, respectively, which significantly reduced to 14.5 ± 0.7 mmHg and 11.6 ± 0.6 mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038).

CONCLUSION

AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Short-Term Outcomes of Trabeculectomy With or Without Anti-VEGF in Patients With Neovascular Glaucoma: A Systematic Review and Meta-Analysis

Objectives

The aim of this study was to compare the safety and efficacy of trabeculectomy alone or combined with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents for the treatment of neovascular glaucoma.

Methods

We conducted a systematic review and meta-analysis to compare the effects of trabeculectomy alone or combined with intravitreal injections of anti-VEGF agents for the treatment of neovascular glaucoma. We searched four databases (PubMed, Cochrane Library, Embase, and Web of Science) up to January 2023 and extracted data on three surgical outcomes: postoperative intraocular pressure, success rate and complications. We used a random-effects model to calculate pooled relative risk (RR) or standardized mean difference (SMD) estimates and 95% confidence intervals (CIs). We assessed publication bias using Begg and Egger tests.

Results

We included seven studies with 353 eyes. Compared to trabeculectomy alone, trabeculectomy with anti-VEGF had a lower risk of postoperative complications (RR, 0.60; 95% CI, 0.41-0.89) and higher success rate (RR, 1.19; 95% CI, 1.02-1.40). The intraocular pressure reduction was significantly greater in the trabeculectomy with anti-VEGF augmentation group than the trabeculectomy group from 1 week (SMD, -1.36; 95% CI, -2.76 to 0.04) to 6 months (SMD, -0.79; 95% CI, -1.50 to -0.07) after surgery.

Conclusions

According to current evidence, adding intravitreal injection of anti-VEGF agents to trabeculectomy may improve the short time outcomes of patients with neovascular glaucoma.

Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma

Purpose

To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase.

Design

Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up.

Methods

Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit. Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM).

Results

A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included. Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively. Baseline IOP was significantly higher in the HTN phase group (p = 0.001). Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180). At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups. PO complications were comparable and uncommon in both groups.

Conclusion

Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6. However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term.

How to cite this article

Ramesh S, Shalaby WS, Myers JS, et al. Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma. J Curr Glaucoma Pract 2023;17(2):91-97.

A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment

Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.

A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma

Purpose

Methods

Results

Conclusion

How to cite this article

Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma

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.

The influence of etiology on surgical outcomes in neovascular glaucoma

Background

The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD).

Methods

This was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision.

Results

One hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation.

Conclusions

In our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.

The study of the efficiency of micropulse transscleral cyclophotocoagulation in the combined treatment of patients with secondary neovascular glaucoma

Background: Neovascular glaucoma (NVG) is a highly refractory form, it is characterized by fast development and a high level of the intraocular pressure (IOP). Aims: To evaluate the effectiveness of micropulse transscleral cyclophotocoagulation (mCPC) in the combined treatment of patients with secondary neovascular glaucoma. Methods: The study included 32 patients (32 eyes) with secondary NVG as an outcome of diabetes mellitus and (or) thrombosis of the central retinal vein or its branches. The preoperative IOP averaged 38.88.8 mm Hg with the most intense hypotensive therapy. All the patients underwent mCPC. In the postoperative period, the patients were examined on the first day after the operation, then in 1 week, 1, 3, 6 months, 1 year after the operation. Results: All the operations were performed without complications. Pain syndrome in all cases was stopped on the first day after surgery. Six patients had reactive hypertension on the first day, therefore, the hypotensive therapy was intensified. The IOP 1 week after mCPC was 20.97.9 mm Hg, after 1 month of observation 23.76.0 mm Hg with the hypotensive therapy. 34 weeks post-surgery, six patients with the preserved visual function experienced a repeated IOP increase, and the Ahmed valve was implanted. 6 months after mCPC, the IOP level averaged 22.87.7 mm Hg with the hypotensive therapy. Against the background of the IOP compensation, anti-VEGF drugs were injected in 4 cases, followed by laser coagulation of the retina. Conclusion: Application of mCPC in NVG glaucoma patients showed only a small number of postoperative complications. This method of laser treatment can be used in combination with panretinal laser coagulation before or after the surgery, including administration of anti-VEGF drugs before or after the surgery. In case of the IOP increase, mCPC may be repeated.

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 12mo and 15.8±9.1 mm Hg at 24mo of follow up. Cumulative incidence of success of IOP control was 76.0% at first postoperative month, reaching 88.3% at 6mo. Prevalence of successful IOP control at long term was 74.4% at 12mo and 71.4% at 24mo. 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.

Early Surgical Intervention for Neovascular Glaucoma in a Patient with Diabetes

Neovascular glaucoma (NVG) is a cause of blindness in patients with proliferative diabetic retinopathy (PDR) and remains a clinical challenge. It results from vascular endothelial growth factor (VEGF) expression, which occurs in cases of severe retinal ischemia. Early detection and immediate comprehensive management, including early surgical intervention, are essential to maintain good intraocular pressure (IOP) control and achieve the best visual outcome, as presented in this case. A 42-year-old male patient with bilateral NVG secondary to PDR received complex management with early Ahmed valve implantation surgery, followed by pan-retinal photocoagulation (PRP) and intravitreal bevacizumab injection. After 22 months of treatment and follow-up, we could achieve the best visual outcome for the patient. Early surgical intervention for uncontrolled NVG with a glaucoma filtration device combined with intravitreal anti-VEGF injections and adequate PRP showed beneficial effects in the IOP control with rapid resolution of iris neovascularization, thus achieving the best visual function.

Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma

Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for refractory glaucoma. The new autologous scleral pocket technique is performed by inserting the tube into the vitreous cavity without using a donor scleral patch. The purpose of this study was to evaluate the surgical results of Ahmed glaucoma valve (AGV) implantation using this technique for neovascular glaucoma (NVG), which is one of the representative refractory types of glaucoma. This observational retrospective case series included 15 consecutive eyes of 15 patients with NVG who had undergone AGV implantation at Kobe University between January 2018 and December 2019. The mean preoperative intraocular pressure (IOP) was 37.2 ± 13.8 mmHg and the glaucoma drug score was 4.2 ± 2.2. The mean IOP and glaucoma drug score at 1 year postoperatively decreased to 15.0 ± 4.6 mmHg and 1.3 ± 2.0, respectively (p < 0.001). No significant change in the corneal endothelial cell density following surgery was observed (p = 0.09); however, one patient required an additional trabeculectomy at 7 months postoperatively. No cases of tube exposure or conjunctival erosion were observed at 1 year postoperatively. These results indicated the effectiveness and safety of this technique in patients with NVG.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma - a retrospective interventional case series

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma - a retrospective interventional case series

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.

Outcomes of Valved and Nonvalved Tube Shunts in Neovascular Glaucoma

PURPOSE

To determine the outcomes of Ahmed glaucoma valve (AGV; New World Medical Inc) and Baerveldt glaucoma implant (BGI; Advanced Medical Optics) surgery in the setting of neovascular glaucoma (NVG).

DESIGN

Single-center, retrospective study.

PARTICIPANTS

Consecutive patients who underwent AGV or BGI surgery for the treatment of NVG and had ≥6 months of follow-up.

METHODS

Chart review of AGV and BGI surgical outcomes in patients with NVG.

MAIN OUTCOME MEASURES

Progression to no light perception (NLP) vision and 6-month surgical failure, which was defined as intraocular pressure (IOP) >21 mmHg with medications or <5 mmHg at 2 consecutive visits, or glaucoma reoperation.

RESULTS

A total of 152 eyes (91 AGV, 61 BGI) were included with an average follow-up of 29.6 ± 25.8 months. Baseline demographics and clinical characteristics were comparable between groups. At month 6, failure was similar between AGV and BGI eyes (21.6% vs. 25.9%; P = 0.552), but glaucoma medication use was lower in BGI eyes (P < 0.001). At the final visit, 18.7% of AGV and 14.8% of BGI eyes progressed to NLP vision (P = 0.530), and medication use was lower in BGI eyes (P < 0.0001). Multivariate analysis identified lower preoperative visual acuity (VA) (P = 0.001), failure to receive panretinal photocoagulation within 2 weeks of surgery (P = 0.003), and bilaterality of the underlying ischemic retinal pathology (P = 0.026) as the strongest predictors of NLP outcome. Age, sex, race, NVG etiology, tube type, preoperative IOP, extent of synechial angle closure preoperatively, preoperative hyphema, IOP at the first NLP visit, and final IOP were not significant predictors of NLP vision.

CONCLUSIONS

Eyes with AGV and BGI had comparable outcomes in NVG, although fewer medications were required in BGI eyes to control IOP. Progression to NLP vision was associated with poor baseline VA, delayed retinal treatment, and bilaterality of the underlying ischemic retinal pathology.

Effects of Sanoshashinto on left ventricular hypertrophy and gut microbiota in spontaneously hypertensive rats

In our previous study, we found that the methanolic extract of Sanoshashinto () (SHXXTM) exhibited significant vasorelaxant effects in vitro and antihypertensive effects in vivo, and baicalin and berberine were the main antihypertensive constituents in SHXXTM. We also speculated that the baicalin-berberine (BB) combination produced vasorelaxant effects by activating the NO/cGMP pathway, and the BK_Ca channel and the DAG/PKC/CPI-17 pathway were involved. In this study, we examined the vasorelaxant effects using helical strips of rat aorta pretreated with different activators or inhibitors. The results suggested that the K_ATP channel and the voltage-dependent Ca²⁺ channel (VDCC) were also involved in the vasorelaxant effects. Furthermore, we found that SHXXTM and the BB combination reduced left ventricular hypertrophy and altered gut microbiota. Together, the results indicated that Sanoshashinto might have comprehensive effects on ameliorating hypertension.