1
|
Ramesh PV, Ray P, Joshua T, Devadas AK, Raj PM, Ramesh SV, Ramesh MK, Rajasekaran R. The photoreal new-age innovative pedagogical & counseling tool for glaucoma with 3D augmented reality (Eye MG AR). Eur J Ophthalmol 2024; 34:870-873. [PMID: 36880748 DOI: 10.1177/11206721231159249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
In this manuscript, we have reported an augmented reality (AR) application named, 'Eye MG AR' innovated by us, to show different anatomical/pathological parts of the eyeball pertaining to glaucoma, from multiple customized angles of the user's choice to simplify glaucoma learning and clinical counseling. It is available free of cost from the Google Play Store for Android users. Procedures ranging from a simple outpatient department procedure (yttrium aluminium garnet peripheral iridotomy) to a complex surgical technique (trabeculectomy/tube surgery) can be explained and counseled with this Android application. Also, complex structures such as the angle of the anterior chamber and optic nerve head, are constructed in advanced real-time three-dimensional (3D) high-resolution confocal images. These 3D models are useful for glaucoma neophytes' immersive learning and 3D patient counseling experiences. This AR tool aims to reinvent the approach to glaucoma counseling with 'Unreal Engine' software and is created in a patient-friendly approach. Incepting 3D pedagogy and counseling with AR in glaucoma with real-time and high-resolution TrueColor confocal images has never been reported in the literature according to our knowledge.
Collapse
Affiliation(s)
- Prasanna Venkatesh Ramesh
- Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Prajnya Ray
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Tensingh Joshua
- Department of Research and Animation, Mahathma Centre of Moving Images Private Limited, Trichy, Tamil Nadu, India
| | - Aji Kunnath Devadas
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Prakash Michael Raj
- Department of Research and Animation, Mahathma Centre of Moving Images Private Limited, Trichy, Tamil Nadu, India
| | - Shruthy Vaishali Ramesh
- Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Meena Kumari Ramesh
- Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| | - Ramesh Rajasekaran
- Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
| |
Collapse
|
2
|
Khan SM, Rao A. Trabeculectomy with concurrent intravitreal bevacizumab in neovascular glaucoma. Indian J Ophthalmol 2024; 72:386-390. [PMID: 38099585 PMCID: PMC11001224 DOI: 10.4103/ijo.ijo_676_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To evaluate the clinical efficacy of concurrent intravitreal bevacizumab (IVB) injection with trabeculectomy with mitomycin-C (MMC) in neovascular glaucoma (NVG). METHODS Patients with NVG who underwent trabeculectomy with concurrent IVB (group 1) and those who underwent IVB sequentially, followed by trabeculectomy with MMC (group 2) in 1-2 weeks between January 2021 and August 2022, were included in this retrospective hospital-based study. The need for medications for intraocular pressure (IOP) control at 6 months in the two groups was the primary outcome measured and compared between the groups. The association of the need for medications postoperatively with clinical variables was assessed using stepwise multivariate regression statistics. RESULTS We finally included 40 patients ( n = 12 in group 1, n = 28 in group 2) with no significant differences in presenting age between groups. The IOP at 1 day and 1 week were not significantly different between groups though the IOP at 1, 3, and 6 months. IOP was lower in group 1 eyes with the 6-month IOP, being significantly lower in group 1, P = 0.05. Three eyes in group 1 and 11 eyes in group 2 required anti-glaucoma medications in the postoperative period. Multivariate regression identified preoperative IVB >3 (β =0.7, P < 0.001) and recurrent vitreous hemorrhage (β = 0.7, P = 0.004) as prognostic factors ( R2 = 40.6%) determining the need for anti-glaucoma medication (AGM) postoperatively in both groups. CONCLUSION Concurrent IVB with trabeculectomy with mitomycin-C is a feasible alternative in patients with NVG with refractory high-presenting IOP. This may serve to address raised IOP as well as retinal ischemia, thereby improving surgical success rates in the most challenging NVG cases.
Collapse
Affiliation(s)
- Sardar M Khan
- Glaucoma Services, L. V. Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
| | - Aparna Rao
- Glaucoma Services, L. V. Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
| |
Collapse
|
3
|
Bhadra TR, Ghosh RP, Mitra A, Saurabh K, Mandal SK, Ghosh AK. Comparative study of the outcomes of newly developed polypropylene-based modified trabeculectomy and glaucoma shunt surgery in neovascular glaucoma. Indian J Ophthalmol 2024; 72:352-356. [PMID: 38421291 PMCID: PMC11001222 DOI: 10.4103/ijo.ijo_3362_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Neovascular glaucoma (NVG) is a secondary glaucoma with a poor visual prognosis. Trabeculectomy with antifibrotic agents, glaucoma drainage devices (GDDs), and cyclo-destructive procedures are recommended in patients who are refractory to medical management. However, due to the poor success rate of conventional trabeculectomy and the higher cost of GDDs, alternative procedures need to be looked at. PURPOSE To compare the surgical outcomes and economic aspects of a newly developed polypropylene suture bed-based modified trabeculectomy to Ahmed glaucoma valve (AGV) implantation for NVG. METHODS It was a prospective interventional study conducted at a tertiary care center between 2018 and 2020. Consecutive patients with NVG with a minimum follow-up of 18 months were included. Surgical outcomes are mainly based on intraocular pressure (IOP) control and the cost of surgery. RESULTS Sixty eyes were included out of which 40 (60.6%) underwent modified trabeculectomy and 20 (33.7%) underwent AGV. At the final follow-up, no significant difference (P < 0.05) was found between the surgical outcomes of both groups. The complete success rate (IOP < 21 mm Hg without antiglaucoma medications) was 60 and 65% while the qualified success rate (IOP < 21 mm Hg with antiglaucoma medications) was 30 and 25% in modified trabeculectomy and AGV groups, respectively, at final follow-up. The cost of surgery was significantly higher in the AGV group (P < 0.0001). CONCLUSION Modified trabeculectomy as described might be a better alternative for NVG eyes.
Collapse
Affiliation(s)
- Tania Ray Bhadra
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| | - Rudra Prosad Ghosh
- Department of Ophthalmology, Rampurhat Government Medical College, Birbhum, West Bengal, India
| | - Ankita Mitra
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| | - Kumar Saurabh
- Retina Services, Dr. Agarwal's Eye Hospital, Salt Lake, Kolkata, West Bengal, India
| | - Salil Kumar Mandal
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| | - Asim Kumar Ghosh
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| |
Collapse
|
4
|
Bayraktar S, Acar A, Şekeroğlu MA. A Rare Association: Neovascular Glaucoma Accompanying Anterior Chamber Synchysis Scintillans. Turk J Ophthalmol 2024; 54:49-51. [PMID: 38008935 PMCID: PMC10895167 DOI: 10.4274/tjo.galenos.2023.39016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Synchysis scintillans, also known as cholesterolosis bulbi, is a degenerative eye pathology characterized by the accumulation of cholesterol crystals in the vitreous. It is typically observed bilaterally but can rarely be unilateral. It can be triggered by severe trauma, chronic inflammation, chronic retinal detachment, hyphema, vitreous hemorrhage, Coats’ disease, and retinoblastoma. In this report, we present a case with an uncommon association of anterior chamber synchysis scintillans and neovascular glaucoma.
Collapse
Affiliation(s)
| | - Atakan Acar
- Etlik City Hospital, Clinic of Ophthalmology, Ankara, Türkiye
| | | |
Collapse
|
5
|
Gan YK, Birapadian SM, Abdul Jalal MI, Din NM. Baerveldt glaucoma implant with Supramid © ripcord stent in neovascular glaucoma: a case series. Int J Ophthalmol 2024; 17:265-271. [PMID: 38371250 PMCID: PMC10827610 DOI: 10.18240/ijo.2024.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/29/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To report the outcome of Baerveldt glaucoma implant (BGI) with Supramid© ripcord use in neovascular glaucoma (NVG). METHODS We retrospectively evaluated the surgical outcome of the BGI with Supramid© 3/0 ripcord stent in patients with NVG. No tube ligation or venting slits were performed. Supramid was removed after 3mo if the target intraocular pressure (IOP) was not achieved. Surgical success was defined as IOP≤21 mm Hg with (qualified success) or without IOP-lowering medications (complete success). RESULTS Twenty-six eyes from 24 patients were included in the study. The median duration of follow-up was 4 [interquartile range (IQR)=1-5]y, ranging from 0.5 to 5y. IOP decreased by a mean of 24.2 mm Hg (59.7%); from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg, P≤0.001. The number of glaucoma medications reduced from a median of 5 (IQR=5-6) to 1 (IQR=0-2, P≤0.001) at the final follow-up. Overall success rates were 88.0% at 1y, 34.8% at 3y, 66.7% at 4y, and 50% at 5y. Hypertensive phase (HP) in the first 3mo occurred in 15/26 eyes (57.7%) with a mean IOP of 31.1 mm Hg. CONCLUSION BGI with Supramid© ripcord stent gives close to 90% of the overall survival rate at the final follow-up without significant early hypotony. However, early HP is still a challenge.
Collapse
Affiliation(s)
- Yuen Keat Gan
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Shiivaa Manjare Birapadian
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | | | - Norshamsiah Md Din
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| |
Collapse
|
6
|
Husain KA, Alaali H, Alarayedh GG. Prevalence and Characteristics of Glaucoma Among Patients Presenting to Ophthalmology Clinics in a Tertiary Hospital in the Kingdom of Bahrain. Cureus 2024; 16:e54129. [PMID: 38487113 PMCID: PMC10939155 DOI: 10.7759/cureus.54129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction The aim of this study was to determine the prevalence and characteristics of glaucoma in patients presenting to the ophthalmology department in a tertiary hospital in Bahrain for the first time. Methods A retrospective study was conducted at the Salmaniya Medical Complex, Manama, Bahrain. The medical records of all patients who presented for the first time to an eye clinic between January and December 2019 were reviewed. Patients who were diagnosed with glaucoma were included in this study. Data regarding age, sex, ethnicity, type of glaucoma, previous treatment, best corrected visual acuity, cup-to-disc ratio, intraocular pressure, central corneal thickness, optical coherence tomography (OCT) retinal nerve fiber layer (RNFL), and visual field findings were collected. Results Of a total of 18,238 new patients in 2019, 173 patients (0.97%) had glaucoma. The mean age of patients with glaucoma was 59.6 ± 11.3 years and approximately 60% of them were males (n=103, 59.5%). In 93% of the cases, glaucoma involved both eyes (n=161). Primary open-angle glaucoma (n=97, 56.1%), normal tension glaucoma (n=28, 16.2%), and chronic angle closure glaucoma (n=15, 8.7%) were the most frequently encountered types of glaucoma. Approximately 16.76% (n=29) of the patients were blind in one or two eyes at the time of presentation. Conclusion There seems to be a low prevalence of glaucoma among the encountered cases on the first visit to ophthalmology clinics in Bahrain, with primary open-angle glaucoma being the most common type.
Collapse
Affiliation(s)
- Khatoon A Husain
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
| | - Haneen Alaali
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
| | | |
Collapse
|
7
|
Alabduljabbar K, Bamefleh DA, Alzaben KA, Al Owaifeer AM, Malik R. Cyclophotocoagulation versus Ahmed Glaucoma Implant in Neovascular Glaucoma with Poor Vision at Presentation. Clin Ophthalmol 2024; 18:163-171. [PMID: 38250598 PMCID: PMC10799570 DOI: 10.2147/opth.s424321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To evaluate the outcomes of surgical intervention in eyes with neovascular glaucoma (NVG) and poor vision, comparing the Ahmed glaucoma implant with cyclophotocoagulation (CPC). Patients and Methods This study is a double-armed cohort retrospective review of medical records of patients with NVG who had a visual acuity of 20/200 or less and underwent one of the two procedures as a primary intervention: Ahmed glaucoma valve (AGV) or cyclophotocoagulation (CPC). The study was conducted at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, from January 2014 to June 2019, with a total study period of 1 year. The main outcome measures included the surgical success rate, changes in intraocular pressure (IOP), the number of antiglaucoma medications, corrected distance visual acuity, and the reoperation rate for glaucoma. Results The preoperative IOP was 40.4 ± 10.6 mmHg (Median 40) in the CPC group and 39.4 ± 10.2 mmHg (Median 40) in the AGV group (P = 0.6). At 1 year, the IOP ranged from 12.5 to 28 mmHg (Median 18) in the CPC group and 14 to 21.5 mmHg (Median 17) in the AGV group (P = 0.016). Survival analysis showed a 51% success rate in the CPC group and an 89% success rate at 1 year in the AGV group (p>0.0001). Conclusion CPC and AGV procedures yielded good outcomes with similar IOP levels 12 months after the surgery. However, AGV demonstrated a higher overall success rate and a lower medication requirement than CPC.
Collapse
Affiliation(s)
- Khaled Alabduljabbar
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Dania A Bamefleh
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khawlah Adel Alzaben
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Adi M Al Owaifeer
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Rizwan Malik
- Department of Surgery, Sheikh Khalifa Hospital, Abu Dhabi, United Arab Emirates
| |
Collapse
|
8
|
Qu S, Zou Y, Yang L, Wu H. The progress of assessment methods and treatments of neovascular glaucoma secondary to central retinal vein occlusion. Front Med (Lausanne) 2024; 10:1280776. [PMID: 38259837 PMCID: PMC10800625 DOI: 10.3389/fmed.2023.1280776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Neovascular glaucoma is a condition that results from central retinal vein occlusion and often leads to blindness. Accurate evaluation and appropriate treatment are crucial for patients. However, there is currently no uniform and clear standard to differentiate between ischemic and non-ischemic central retinal vein occlusion. Also, the assessment of neovascular glaucoma progression is uncertain. Meanwhile, although pan-retinal photocoagulation is a standard treatment to prevent the onset of neovascular glaucoma, its actual efficacy and the timing of intervention remain highly controversial. It is still challenging to balance the risks of side effects in the visual field against the uncertain effectiveness of the treatment. This paper delves into the pathogenesis of neovascular glaucoma to understand the development of therapeutic approaches. By taking into account various assessment criteria of central retinal vein occlusion and neovascular glaucoma over the years, combining functional tests and morphological tests provides the most accurate and rigorous solution. The age of patients, the extent, location, and duration of retinal ischemia are the primary factors that affect the severity and extent of ischemic central retinal vein occlusion and induce serious complications. From the perspective of prevention and treatment, the ischemic index is closely related to the development of neovascularization. The paper provides essential insights into the mechanism, efficacy, complications, and optimal timing of pan-retinal photocoagulation. Comparing the treatment effects of pan-retinal photocoagulation and intravitreal anti-VEGF injections, we suggest a combination of both treatments to explore effective treatment with fewer side effects in the long term. This article details the debate on the above issues and explores ideas for the clinical diagnosis and preventive treatment of neovascular glaucoma that results from ischemic central retinal vein occlusion.
Collapse
Affiliation(s)
| | | | | | - Hong Wu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| |
Collapse
|
9
|
Kadam Y, Thaku P, Das AV, Narayanan R, Senthil S, Takkar B. Hemi-retinal vein occlusion: Characterizing a rare retinal vasculopathy. Indian J Ophthalmol 2024; 72:02223307-990000000-00071. [PMID: 38189486 PMCID: PMC7615980 DOI: 10.4103/ijo.ijo_1712_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/20/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To characterize hemi-retinal vein occlusion (HRVO) in patients presenting to a multi-tier ophthalmology hospital network. METHODS This retrospective, hospital-based study analyzed 2,834,616 new patients between August 2010 and June 2021. Patients with a clinical diagnosis of HRVO in at least one eye were included as cases. Data were collected using an electronic medical record system. Data were compared to the findings noted in branch RVO (BRVO) and central RVO (CRVO) patients. RESULTS HRVO constituted 0.9% (n = 191) of all the retinal vein occlusions (RVOs), with the mean age being 60.55 ± 10.14 years. Most patients were male (125, 65.45%) with unilateral (92.67%) affliction. Majority presented during the sixth (31.41%) or seventh (32.46%) decade of life. Most patients reported mild (37.07%) or moderate (27.32%) visual impairment, with vision < 20/200 being less common in HRVO (25.8%) and BRVO (17.2%) compared to CRVO (44.1%) (P < 0.00001). Glaucoma was diagnosed and treated in 49 (23.90%) eyes, which was much higher than CRVO (11.45%) and BRVO (5.04%) (P < 0.001), though neovascular glaucoma was much less than CRVO (2.9% vs. 9.2%) (P = 0.0037). On follow-up, HRVO eyes (12.2%) had lesser vision loss compared to CRVO eyes (13.7%) (this difference does not look very significant to me), though BRVO had the least (9.1%) vision loss. CONCLUSION HRVO is a rare RVO, presenting more in males. It causes less-severe visual impairment compared to CRVO. Large majority of patients with HRVO do not have identifiable systemic risk factors other than age. Preexisting glaucoma was more associated with HRVO compared to other RVOs.
Collapse
Affiliation(s)
- Yogita Kadam
- Department of EyeSmart EMR and AEye, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
| | - Pratima Thaku
- Anant Bajaj Retina Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of EyeSmart EMR and AEye, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, Hyderabad, Telangana, India
| |
Collapse
|
10
|
Chawla H, Redrick HJ, Pannell JT, Goldblatt NP, Mazzulla DA, Benevento JD, Puri S. Incidence of Total Blindness After Central Retinal Artery Occlusion With Ocular Neovascularization. J Vitreoretin Dis 2024; 8:75-81. [PMID: 38223773 PMCID: PMC10786077 DOI: 10.1177/24741264231213169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To determine the time-based incidence of total blindness after central retinal artery occlusion (CRAO) with secondary ocular neovascularization (ONV). Methods: In this retrospective cohort study, electronic records were queried using ICD-9 and ICD-10 codes to identify patients with secondary ONV post-CRAO. Patients with possible alternative ONV etiologies, previous panretinal photocoagulation (PRP), and/or previous antivascular endothelial growth factor (anti-VEGF) therapy were excluded. Clinical data included demographics, medical comorbidities, ONV manifestations, medical/surgical management, and best-corrected visual acuity (BCVA). Kaplan-Meier analysis was performed with total blindness (defined as a BCVA of no light perception) as the outcome of interest. Results: Of 345 eyes with CRAO, 34 met the inclusion criteria with a mean (±SD) follow-up of 22.0 ± 26.2 months. ONV management included PRP (70.6%), glaucoma drainage implant surgery or transscleral cyclophotocoagulation (32.4%), and intravitreal anti-VEGF therapy (mean 2.8 ± 5.6 injections per patient). The cumulative incidence of total blindness was 49.4% (95% confidence interval, 27.2%-71.6%) at 24 months, with 53.3% of cases occurring within 4 months of ONV onset. Conclusions: Post-CRAO ONV is associated with a high risk for progression from severe vision loss to total blindness. Neovascular glaucoma can present up to 4 months after CRAO, challenging the paradigm of "30-day-glaucoma." Routine gonioscopy should extend through this period, while glaucoma surgery can delay further vision loss. These findings can be used to counsel patients on the importance of follow-up adherence.
Collapse
Affiliation(s)
- Harshvardhan Chawla
- Department of Ophthalmology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Hayley J. Redrick
- Department of Ophthalmology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Joshua T. Pannell
- Department of Ophthalmology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Nathaniel P. Goldblatt
- Department of Ophthalmology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - D. Anthony Mazzulla
- Division of Vitreoretinal Surgery, Department of Ophthalmology, Ochsner Medical Center, New Orleans, LA, USA
| | - Joseph D. Benevento
- Division of Vitreoretinal Surgery, Department of Ophthalmology, Ochsner Medical Center, New Orleans, LA, USA
| | - Sidharth Puri
- Division of Vitreoretinal Surgery, Department of Ophthalmology, Ochsner Medical Center, New Orleans, LA, USA
| |
Collapse
|
11
|
Gao S, Lin Z, Zhong Y, Shen X. Clinical Efficacy of Preoperative and Intraoperative Intravitreal Ranibizumab as Adjuvant Therapy of Ahmed Glaucoma Valve Implantation Combined with Vitrectomy in the Management of Neovascular Glaucoma with Diabetic Vitreous Hemorrhage. J Pers Med 2023; 14:18. [PMID: 38248719 PMCID: PMC10821123 DOI: 10.3390/jpm14010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) is a devastating ocular disease with poor prognosis. Intravitreal ranibizumab injection (IVR) has been used as adjuvant therapy of surgical interventions preoperatively or intraoperatively. This study aimed to determine the efficacy and safety of combined IVR as adjuvant therapy in treating NVG with vitreous hemorrhage (VH) in PDR. A total of 39 NVG patients with VH (39 eyes) received IVR 3 to 5 days before surgery, and then they were assigned to either pars plana vitrectomy (PPV) + Ahmed glaucoma valve (AGV) implantation (Group 1, n = 22) or PPV + AGV implantation + intraoperative IVR (Group 2, n = 17). Patients were followed up for at least 9 months. Intraocular pressure (IOP), anti-glaucoma medications, best corrected visual acuity (BCVA), surgical success rates and postoperative complications were compared. Results showed that IOP decreased promptly after surgery and was notably maintained at a mid-term follow-up in both groups, and no significant differences were observed (all p > 0.05). Additional intraoperative IVR significantly reduced postoperative recurrent VH and iris neovascularization (p = 0.047, p = 0.025, respectively). There was no remarkable difference in postoperative anti-glaucoma medications, BCVA and complications between two groups (all p > 0.05). In conclusion, preoperative and intraoperative IVR as adjuvant therapy of AGV implantation combined with PPV could be a safe and effective treatment for NVG with VH in PDR. An additional intraoperative anti-VEGF injection could significantly reduce postoperative VH and iris neovascularization.
Collapse
Affiliation(s)
- Shuang Gao
- Department of Ophthalmology, Ruijin Hospital, Affiliated Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Zhongjing Lin
- Department of Ophthalmology, Renji Hospital, Affiliated Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yisheng Zhong
- Department of Ophthalmology, Ruijin Hospital, Affiliated Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital, Affiliated Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
12
|
Si S, Chen A, Ji Y, Wang J. Poor response to first intravitreal injection for predicting unfavorable outcomes of retinal vein occlusion related macular edema. Eur J Ophthalmol 2023:11206721231214145. [PMID: 37968848 DOI: 10.1177/11206721231214145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSES To screen key indicators leading to unfavorable outcomes of retinal vein occlusion related macular edema (RVO-ME) within long-term follow-up duration and to evaluate their predictive values. METHODS A study involving patients with RVO-ME was conducted between April 2021 and September 2022. All eligible patients were divided into two groups (favorable and unfavorable group) according to their final best corrected visual acuity (BCVA) and whether neovascular glaucoma (NVG) occurred. The unfavorable group was further divided into subgroups 1 (with BCVA of ≥ 20/400 and < 20/60 and without NVG) and 2 (blindness group, with BCVA of < 20/400 or with NVG). Demographic, past medical history, ocular characteristics and blood parameters were compared between the groups. RESULTS A total of 73 eyes from 73 Chinese Han patients (34 males vs. 39 females) with RVO-ME were enrolled. In multivariable regression analysis of continuous variables for unfavorable results, 1-month BCVA after the first intravitreal injection (IVI) was an independent risk factor (odds ratios (ORs) = 2.313, 95% confidence interval (CI) 1.387-3.858, P = 0.001). The area under the curve (AUC) of 1-month BCVA after the first IVI for predicting low vision and blindness was 0.948 (95% CI 0.859-1.000, P < .001) and 0.892 (95% CI 0.744-1.000, P < .001), with a cut-off value of 0.65 logarithm of the minimum angle of resolution (log MAR) (Snellen 20/90) and 1.15 log MAR (Snellen 20/300), respectively. CONCLUSION The most valuable indicator for predicting low vision and blindness was poor 1-month BCVA after first IVI compared with favorable group.
Collapse
Affiliation(s)
- Shancheng Si
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Anming Chen
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yicong Ji
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jing Wang
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
13
|
Zhou X, Chen J, Luo W, Du Y. Short-Term Outcomes of Trabeculectomy With or Without Anti-VEGF in Patients With Neovascular Glaucoma: A Systematic Review and Meta-Analysis. Transl Vis Sci Technol 2023; 12:12. [PMID: 37728893 PMCID: PMC10516766 DOI: 10.1167/tvst.12.9.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Xi Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jun Chen
- Department of Ophthalmology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping, Fujian, China
| | - Wenjing Luo
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|
14
|
Fan FF, Ge X, Liu DD, Xu TY, Wang RX, Chen XY, Li SY. Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma. Int J Ophthalmol 2023; 16:897-903. [PMID: 37332547 PMCID: PMC10250935 DOI: 10.18240/ijo.2023.06.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/18/2023] [Indexed: 06/20/2023] Open
Abstract
AIM To compare the clinical efficacy and safety of ultrasonic cycloplasty (UCP) vs Ahmed glaucoma drainage valve implantation (ADV) in addition to intravitreal anti-vascular endothelial growth factor (VEGF) for treatment of fundus disease-related neovascular glaucoma (NVG). METHODS A total of 43 patients (45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients (15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients (30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure (IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded. RESULTS The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively (P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0% (27/30) in the ADV group and 86.7% (13/15) in the UCP group at the last follow-up of 6mo (P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups (both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation (P<0.05). CONCLUSION UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.
Collapse
Affiliation(s)
- Fang-Fang Fan
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Xing Ge
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Dan-Dan Liu
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Teng-Yu Xu
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Rui-Xue Wang
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Xiao-Ya Chen
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou 221000, Jiangsu Province, China
| | - Su-Yan Li
- The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Department of Ophthalmology, Xuzhou First People's Hospital, Xuzhou 221000, Jiangsu Province, China
- Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou 221000, Jiangsu Province, China
| |
Collapse
|
15
|
Barkhane Z, Qureshi M, Jamil A, Chowdhury P, Kamran M, Altayb Ismail MA, Saeed S. Murphy's Law and Ophthalmic Complications in a Patient With Type 1 Diabetes Mellitus. Cureus 2023; 15:e40584. [PMID: 37469817 PMCID: PMC10353264 DOI: 10.7759/cureus.40584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
Diabetes can lead to various acute clinical complications, although the occurrence of ophthalmic signs and symptoms is uncommon. Neovascular glaucoma (NG), a rare complication associated with diabetes mellitus, is one such condition. Additionally, anti-vascular endothelial growth factor (VEGF)-induced toxic anterior segment syndrome (TASS) is a rare complication of intravitreal bevacizumab. In this case report, we present a unique case of a patient with juvenile diabetes (type 1 diabetes mellitus) who presented to the emergency room (ER) with typical features of diabetic ketoacidosis (DKA) accompanied by bilateral ocular pain. Subsequent investigation revealed secondary angle-closure neovascular glaucoma as the underlying cause. The patient received management for DKA in the ER and subsequent medicine ward. Various interventions were performed for glaucoma in the right eye, including addressing cataracts, which ultimately resulted in TASS. The patient was successfully treated with cryo-diode laser therapy.
Collapse
Affiliation(s)
- Zineb Barkhane
- Faculté de Médecine et de Pharmacie, Université Hassan II de Casablanca, Casablanca, MAR
| | - Maria Qureshi
- Family Medicine, Ayub Medical College, Abbottabad, PAK
| | - Ahmed Jamil
- Internal Medicine, Mayo Hospital Lahore Pakistan, Lahore, PAK
| | | | | | | | - Shahzeb Saeed
- Internal Medicine, Army Medical College Rawalpindi, Islamabad, PAK
| |
Collapse
|
16
|
Tang Y, Shi Y, Fan Z. The mechanism and therapeutic strategies for neovascular glaucoma secondary to diabetic retinopathy. Front Endocrinol (Lausanne) 2023; 14:1102361. [PMID: 36755912 PMCID: PMC9900735 DOI: 10.3389/fendo.2023.1102361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
Neovascular glaucoma (NVG) is a devastating secondary glaucoma characterized by the appearance of neovascular over the iris and the proliferation of fibrovascular tissue in the anterior chamber angle. Proliferative diabetic retinopathy (PDR) is one of the leading causes of NVG. Currently increasing diabetes population drive the prevalence rate of NVG into a fast-rising lane. The pathogenesis underlying NVG makes it refractory to routine management for other types of glaucoma in clinical practice. The combination of panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (VEGF) injections, anti-glaucoma drugs, surgical intervention as well as blood glucose control is needed. Early diagnosis and aggressive treatment in time are crucial in halting the neovascularization process and preserving vision. This review provides an overview of NVG secondary to diabetic retinopathy (DR), including the epidemiology, pathogenesis and management, so as to provide a better understanding as well as potential therapeutic strategies for future treatment.
Collapse
Affiliation(s)
- Yizhen Tang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Yan Shi
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Zhigang Fan
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
- *Correspondence: Zhigang Fan,
| |
Collapse
|
17
|
Dărăbuș DM, Pac CP, Munteanu M. Retinal vein occlusions associated or complicated with glaucoma. Aspects of prediction and paths of progression. Rom J Ophthalmol 2023; 67:97-103. [PMID: 37089806 PMCID: PMC10117181 DOI: 10.22336/rjo.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Objectives: The aim of the study is to evaluate prediction factors and progression paths when retinal vein occlusions are associated with preexisting glaucoma or complicated with neovascular glaucoma. Materials and Methods: The study included 111 patients diagnosed with retinal vein occlusions, of whom 21 with preexisting open angle glaucoma and 12 with neovascular glaucoma as complication. The study was conducted from September 2020 to September 2022 in Timişoara, Romania. We assessed intraocular pressure, cup-disc ratio and retinal nerve fiber layer from the moment of retinal vein occlusion diagnosis until at least one year of follow-up, considering these aspects as values of prediction concerning the paths of progression when glaucoma and retinal vein occlusions come together. Results: The mean initial IOP for the affected eyes was higher (15.89 ± 2.73) than for fellow eyes (15.20 ± 3.11), with an increase of the IOP after one year, but with no statistically significant differences for the affected eyes (p=0.116) or for the other eyes (p=0.684), neither for the affected eyes associated with glaucoma in comparison with affected eyes without glaucoma association. The mean cup-disc ratio was higher for the affected eyes in comparison with the fellow eyes (0.4812 ± 0.219 for the affected eyes and 0.4738 ± 0.229 for the fellow ones in cases without associated glaucoma and 0.681 ± 0.157 for the affected eyes and 0.600 ± 0.241 for the fellow eyes in cases with associated glaucoma), with statistical significant differences in the evolution for both groups in comparison with the unaffected eyes (p=0.0056 for the first group and p=0.0003 for the second group). Comparing the evolution of the affected eyes with the preexisting glaucoma and the affected eyes without preexisting glaucoma, no statistical difference has been found (p=0.1104). The mean retinal nerve fiber layer decreased significantly in affected eyes without glaucoma (from 96 ± 14.71 to 89.16 ± 13.07) and in affected eyes with associated glaucoma (from 78.50 ± 4.23 to 75.50 ± 5.83), but with no significant differences (p=0.182). The level of decreasing was significantly more consistent in association with a venous occlusion (p= 0.0001). Conclusions: The findings of the current study fortify the correlation between glaucoma as a risk factor for retinal venous occlusion development, the intraocular pressure and optic nerve cupping as prediction factors in retinal venous occlusions, the association of a well-controlled preexisting glaucoma with no effect on the progression of the retinal venous occlusions and the development of a neovascular glaucoma with a much aggressive and different path of disease progression.
Collapse
Affiliation(s)
- Diana-Maria Dărăbuș
- Department of Ophthalmology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristina-Patricia Pac
- Department of Ophthalmology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Mihnea Munteanu
- Department of Ophthalmology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| |
Collapse
|
18
|
Babalola YO, Shah MS, Padhy SK, Behera UC. Bilateral astrocytic hamartoma with vasoproliferative tumour in retinitis pigmentosa. Niger Postgrad Med J 2023; 30:81-84. [PMID: 36814168 DOI: 10.4103/npmj.npmj_265_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We report a rare case of a 32-year-old Indian male who presented to the retina outpatient department with a history of sudden worsening of vision in the left eye. There was a background history of poor vision and deficient night vision since childhood. At the first presentation, the best corrected visual acuity was 6/36 and 6/60 in the right and left eye, respectively. Ocular examination revealed waxy pale disc, bone spicule pigmentation, attenuated vessels and epiretinal membrane in the right eye in keeping with retinitis pigmentosa. An astrocytic harmatoma was also present in the right eye. Vitreous haemorrhage in the left eye precluded a view of the fundus. He subsequently had a left pars plana vitrectomy, and intravitreal bevacizumab on account of non-resolving vitreous haemorrhage and a vasoproliferative tumour and astrocytic hamartoma were noticed intraoperatively. He had a good immediate post-operative outcome post-left vitrectomy but subsequently developed left neovascular glaucoma 2 years after. Neovascular glaucoma may be a sequela of vasoproliferative tumour; hence, regular follow-up and monitoring are essential in these patients.
Collapse
Affiliation(s)
- Yewande O Babalola
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India; Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - Miloni S Shah
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India
| | - Srikant K Padhy
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India
| | - Umesh C Behera
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India
| |
Collapse
|
19
|
Urbonavičiūtė D, Buteikienė D, Janulevičienė I. A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment. Medicina (Kaunas) 2022; 58:medicina58121870. [PMID: 36557072 PMCID: PMC9787124 DOI: 10.3390/medicina58121870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Danielė Urbonavičiūtė
- Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania
- Correspondence: ; Tel.: +370-6112-7522
| | - Dovilė Buteikienė
- Department of Ophthalmology, Medical Academy, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| | - Ingrida Janulevičienė
- Department of Ophthalmology, Medical Academy, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| |
Collapse
|
20
|
Jabbehdari S, Yazdanpanah G, Cantor LB, Hajrasouliha AR. A narrative review on the association of high intraocular pressure and glaucoma in patients with retinal vein occlusion. Ann Transl Med 2022; 10:1072. [PMID: 36330401 PMCID: PMC9622479 DOI: 10.21037/atm-22-2730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/14/2022] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Retinal vein occlusion (RVO) is a major cause of vision loss and elevated intraocular pressure (IOP), high ocular perfusion pressure, and glaucoma are known ophthalmic risk factors for RVO. The aim of this paper is to provide the update on the association and management of high IOP/glaucoma and RVO. METHODS A literature review was performed in PubMed and Medline until May 2022 utilizing specific keywords and cross-matched reference lists. KEY CONTENT AND FINDINGS The association of RVO with high IOP/glaucoma may be attributed to retinal ganglion cell loss due to retinal ischemia in high IOP and glaucoma. As new modalities showed, decreased optic disc perfusion, reduced density of blood vessels in the optic nerve head of glaucoma patients, changes in the peripapillary microvascular parameters, and decreased retinal nerve fiber layer (RNFL) thickness of the optic nerve head of eyes with RVO suggest a common pathway between RVO and glaucoma. Literature suggests the close follow up for glaucoma development among patients with non-arteriovenous (AV) crossing (optic cup or optic nerve sited) RVO in fellow eye and management of elevated IOP among RVO cases treated with anti-vascular endothelial growth factor (VEGF) antibodies/corticosteroids and those with preexisting primary open angle glaucoma (POAG). CONCLUSIONS Determining potential patient responses to treatment and considering therapeutic options are challenging among patients with RVO and glaucoma. However, IOP lowering managements in preventing IOP spikes in patients with preexisting glaucoma and early treatment of macular edema in eyes with RVO is recommended.
Collapse
Affiliation(s)
- Sayena Jabbehdari
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Louis B. Cantor
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amir Reza Hajrasouliha
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
21
|
Nishinaka A, Tanaka M, Aoshima K, Kuriyama A, Sasaki T, Otsu W, Yasuda H, Nakamura S, Shimazawa M, Hara H. The pathological association between the anterior eye segment and the retina in a murine model of neovascular glaucoma. FASEB J 2022; 36:e22323. [PMID: 35485981 DOI: 10.1096/fj.202101917r] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
Neovascular glaucoma (NVG) is caused by the formation of new blood vessels in the angle, iris, and cornea in retinal ischemic disease, such as proliferative diabetic retinopathy (PDR) and retinal vein occlusion (RVO), which can reduce the visual acuity. However, the pathophysiological symptoms of NVG are still not well understood because there is no model for the formation of NVG in the angle, iris, and cornea. The aim of this study was to investigate the involvement of NVG during ischemic disease, in a murine model of retinal ischemia. We evaluated the changes of the intraocular pressure (IOP) and pathological symptoms in the anterior eye segment and retina in this model, and the changes in the RNA or protein expression of vascular endothelial growth factor (VEGF) and fibrosis-related factors were analyzed in the retina and cornea by quantitative real-time polymerase chain reaction or western blot, respectively. Furthermore, we examined the changes in IOP after intravitreal injection of an anti-VEGF antibody. First, NVG formed in the retinal ischemic murine model, and the IOP was elevated in mice with NVG formation. Interestingly, VEGF expression was decreased in the retina but increased in the cornea in the murine model of NVG. On the other hand, fibrosis-related factors were increased in the retina and also significantly increased in the cornea in NVG. Moreover, the administration of anti-VEGF antibody immediately after vessel occlusion suppressed the increase in IOP, but administration at 7 days after vessel occlusion accelerated the increase in IOP. These findings suggest that the formation of NVG may be correlated with the pathological symptoms of retinal ischemic disease, via changes in VEGF and fibrosis-related factor expression.
Collapse
Affiliation(s)
- Anri Nishinaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Miruto Tanaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Kota Aoshima
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Aika Kuriyama
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Takahiro Sasaki
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Wataru Otsu
- Department of Biomedical Research Laboratory, Gifu Pharmaceutical University, Gifu, Japan
| | - Hiroto Yasuda
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.,Department of Biomedical Research Laboratory, Gifu Pharmaceutical University, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| |
Collapse
|
22
|
Dubay SK, Dwarika D, Bhola R, Kumar BV. Long-term outcomes of pars plana Ahmed valve implant and vitrectomy in eyes with refractory glaucoma. Med Hypothesis Discov Innov Ophthalmol 2022; 11:44-51. [PMID: 37641700 PMCID: PMC10445320 DOI: 10.51329/mehdiophthal1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/30/2022] [Indexed: 08/31/2023]
Abstract
Background Pars plana vitrectomy with implantation of an Ahmed glaucoma valve in the vitreous cavity has been reported with a success rate in the management of refractory and neovascular glaucoma. This study aimed to present the outcomes of pars plana Ahmed glaucoma valve (PPAV) surgical implantation in cases with refractory glaucoma. Methods In this single-center, retrospective, comparative study, 87 consecutive patients diagnosed with refractory glaucoma who underwent PPAV surgical implantation between October 2015 and October 2019 were evaluated. A successful postoperative outcome was defined as intraocular pressure (IOP) ≤ 21 mmHg upon examination and a reduction in the number of anti-glaucoma agents used at the latest follow-up. Results Finally, 81 eyes of 78 patients with refractory glaucoma were included; 54 (66.66%) of the eyes had neovascular glaucoma. The mean follow-up was 20.65 ± 12.17 months (range: 2-52 months). The mean preoperative IOP was 40.01 ± 1.19 mmHg and reduced significantly to 16.73 ± 0.82 mmHg at the latest follow-up (P < 0.001); a successful IOP outcome was achieved in 88.89% of eyes. The mean number of anti-glaucoma agents decreased significantly from 2.86 ± 0.09 preoperatively to 1.46 ± 0.11 at the latest follow-up (P < 0.001); while 61 (75.31%) of eyes had a reduction in the number of IOP lowering eye drops, and 14 (17.28%) had no need for IOP lowering eye drops. Conclusions PPAV surgery is a successful procedure for IOP reduction in patients with refractory glaucoma. Our study demonstrated either reduction or elimination of IOP lowering eye drops postoperatively. Large scale studies with a comparison group, a longer follow-up, and having various subtypes of glaucoma are required as future research to confirm these outcomes.
Collapse
Affiliation(s)
- Sareta K Dubay
- Trinidad Eye Hospital (Caribbean Vitreous and Retina Surgery Ltd), Trinidad
| | - Dorian Dwarika
- Trinidad Eye Hospital (Caribbean Vitreous and Retina Surgery Ltd), Trinidad
| | - Ronnie Bhola
- Trinidad Eye Hospital (Caribbean Vitreous and Retina Surgery Ltd), Trinidad
| | | |
Collapse
|
23
|
Shalaby WS, Ganjei AY, Wogu B, Myers JS, Moster MR, Razeghinejad R, Lee D, Kolomeyer NN, Eid TE, Katz LJ, Shukla AG. Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma. Indian J Ophthalmol 2022; 70:1253-1259. [PMID: 35326027 PMCID: PMC9240564 DOI: 10.4103/ijo.ijo_2107_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Wesam S Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Allen Y Ganjei
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Brian Wogu
- Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Lee
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Natasha N Kolomeyer
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tarek E Eid
- Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aakriti G Shukla
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
24
|
Nieves-Moreno M, Peralta J, Noval S. Neovascular Glaucoma in Children: A case series and a review of the literature. Eur J Ophthalmol 2022; 32:3289-3294. [PMID: 35132889 DOI: 10.1177/11206721221078678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the uncommon causes and treatment options for neovascular glaucoma in children. PATIENTS AND METHODS A review of the literature on neovascular glaucoma in children was conducted and we present three cases of neovascular glaucoma in children. RESULTS We present three cases of neovascular glaucoma: two cases were secondary to a retinal vasoproliferative tumor-one to neurofibromatosis type 1 and the other to exudative retinopathy secondary to mild retinopathy of prematurity-and one case was secondary to a central retina vein occlusion secondary to an optic nerve glioma. Vision in the affected eye was severely impaired in all the children. CONCLUSION The diagnosis and treatment of neovascular glaucoma in children is challenging and often a complication of a systemic or late-stage ocular condition. An appropriate diagnosis and estimation of the visual potential are essential to determine the correct treatment, especially in young children.
Collapse
Affiliation(s)
- Maria Nieves-Moreno
- Departamento de oftalmología Infantil, 16268Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Peralta
- Departamento de oftalmología Infantil, 16268Hospital Universitario La Paz, Madrid, Spain
| | - Susana Noval
- Departamento de oftalmología Infantil, 16268Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
25
|
Bai L, Wang Y, Liu X, Zheng Y, Wang W, He N, Tariq F, Wang F, Zhang S. The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma. Front Med (Lausanne) 2022; 8:766032. [PMID: 35083234 PMCID: PMC8784790 DOI: 10.3389/fmed.2021.766032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
This study investigates the safety and efficacy of conbercept injection through different routes for neovascular glaucoma (NVG) treatment, in which seventy-four patients (81 eyes) with NVG caused by ischemia retinopathy had participated. Patients were divided into three stages according to the progression of NVG and were randomly assigned to receive intracameral or intravitreal conbercept injection. After conbercept injection, patients experienced improved best-corrected visual acuity (BCVA), good intraocular pressure (IOP) control, and neovascularization of Iris (NVI) regression. In stage III, patients required trabeculectomy with mitomycin C plus pan-retinal photocoagulation (PRP) to achieve complete NVI regression. Compared to the intravitreal group, the intracameral group had significantly lower IOP in 2 days in stage III and 1 day in stages I and II after injection, complete NVI regression before PRP in stages I and II, and better NVI regression in stage III. The rates of hyphema after trabeculectomy and malfunction filtering bleb suffering needle bleb revision were lower in the intracameral group, but only the hyphema rate was significantly different. Injections through different routes are all safe. We recommend intravitreal injections for patients in stages I and II, but for stage III, intracameral injection is better, and trabeculectomy with mitomycin C should be conducted within 2 days after injection to maximally reduce the risk of perioperative hyphema. Trial Registration:ClinicalTrials.gov, identifier NCT03154892.
Collapse
Affiliation(s)
- Ling Bai
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanfen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xindi Liu
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuping Zheng
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenjing Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Na He
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Farheen Tariq
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Geriatric Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
26
|
Palfi (Salavat) MC, Șeclăman EP, Barac R, Ungureanu E, Iorgu G, Artamonov A, Leuștean L, Borugă MV. The role of Anti-VEGF agents in treatment of neovascular glaucoma. Rom J Ophthalmol 2022; 66:209-213. [PMID: 36349171 PMCID: PMC9585493 DOI: 10.22336/rjo.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to show the efficacy of intravitreal treatment with Bevacizumab (Avastin) in patients with secondary neovascular glaucoma, in different stages of the disease. Method: A retrospective study was performed on 67 patients with neovascular glaucoma. The main parameters evaluated were the patients' history, slit lamp examination, visual acuity, ocular tonometry, fundus examination, gonioscopy, and visual field. Results: It was observed that the pathology had a preponderance in males of the 6th decade, with frequently unilateral damage. Patients were referred to an ophthalmologist when the diseases reached an advanced stage, usually when the visual acuity had no light perception and the intraocular pressure was over 45 mmHg. However, the treatment with Avastin intravitreal showed a good evolution, with regression of neovessels in the first 4-7 days and maintenance of intraocular pressure within normal limits in about 60% of cases, 3 months after injection. Conclusion: The most effective treatment in secondary neovascular glaucoma is the correct therapy of the main disease. The association of Avastin and laser photocoagulation leads to regression in iris and retinal neovessels. Abbreviations: anti-VEGF = anti-Vascular Endothelial Growth Factor, PDGF = Platelet Derived Growth Factor, bFGF = basic Fibroblast Growth Factor.
Collapse
Affiliation(s)
| | - Edward Paul Șeclăman
- Department of Biochemistry, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Ramona Barac
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Emil Ungureanu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Mădălina Veronica Borugă
- Department of Toxicology and Drug Industry, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| |
Collapse
|
27
|
Cicinelli MV, Di Nicola M, Gigliotti CR, Battista M, Miserocchi E, Vecchio A, Mortini P, Bandello F, Modorati GM. Predictive factors of radio-induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma. Acta Ophthalmol 2021; 99:e1458-e1466. [PMID: 33638277 DOI: 10.1111/aos.14814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/03/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE To report the factors predictive of radio-induced complications (i.e. radiation retinopathy [RR], radiation papillopathy [RP] and neovascular glaucoma [NVG]) in uveal melanoma (UM) patients undergoing gamma knife radiosurgery (GKR). MATERIALS AND METHODS Longitudinal cohort study on patients with UM treated at the Ocular Oncology Service, San Raffaele Scientific Institute, Milan, between June 1994 and November 2018. Data were retrospectively reviewed. Rates of GKR-related complications were reported. Variables associated with each complication were investigated using multivariable Cox models and confirmed by logistic regression analysis. Hazard ratio (HR) and 95% confidence intervals (CI) were reported for significant associations. RESULTS One hundred ninety-four patients (99 males, 51%) were included, and 184 tumours were primarily located in the choroid (95%). Median follow-up was 57 months (range 6-286). Local control was achieved in 182 eyes (94%), and 152 eyes (78%) experienced at least one radiation-induced complication. Radiation retinopathy was documented in 67 eyes (35%) after a median of 23 months. Older age (HR = 0.97, 95% CI = 0.95-0.99, p = 0.02) had a protective effect for RR. Radiation papillopathy was diagnosed in 35 eyes (18%) after a median of 14 months after GKR. Macular or peripapillary location (HR = 3.06, 95% CI = 1.52-6.16, p = 0.002) was associated with increased risk of RP, while older age was protective (HR = 0.95, 95% CI = 0.93-0.98, p = 0.001). New-onset NVG was found in 53 eyes (27%), and median onset was 28 months. Tumour thickness (HR = 4.41, 95% CI = 2.23-8.72, p < 0.001) and peripapillary location (HR = 2.78, 95% CI = 1.46-5.27, p = 0.002) were the main risk factors associated with NVG. CONCLUSION Understanding factors predictive for radiation-related complications in patients undergoing GKR might help for better counselling and treatment planning.
Collapse
Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | - Maura Di Nicola
- Ocular Oncology Service University of Cincinnati College of Medicine Cincinnati OH USA
| | | | - Marco Battista
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Antonella Vecchio
- Department of Medical Physics IRCCS San Raffaele Scientific Institute Milan Italy
| | - Pietro Mortini
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Neurosurgery and Gamma Knife Radiosurgery IRCCS San Raffaele Scientific Institute Milan Italy
| | - Francesco Bandello
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | | |
Collapse
|
28
|
Kameda Y, Saeki T, Hanai K, Suzuki Y, Uchigata Y, Babazono T, Kitano S. Is Chronic Kidney Disease Affecting the Postoperative Complications of Vitrectomy for Proliferative Diabetic Retinopathy? J Clin Med 2021; 10:5309. [PMID: 34830589 DOI: 10.3390/jcm10225309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) is a well-known risk factor for postoperative complications in several surgical fields. However, although prevalent among diabetic candidates for vitrectomy, the effect of CKD on vitrectomy outcomes remains unclear. This study aimed at clarifying the relationship between CKD and the occurrence of vitrectomy-related complications in patients with proliferative diabetic retinopathy (PDR). The 6-month incidences of vitreous hemorrhage (VH) and neovascular glaucoma (NVG) following vitrectomy for PDR were compared among the following groups: stages 1–2 CKD (60 patients), stages 3–5 CKD (70 patients not on hemodialysis), and hemodialysis (HD; 30 patients). We also determined whether the deterioration of the estimated glomerular filtration rate (eGFR) was associated with post-vitrectomy events. The incidence of VH was significantly higher in the stages 3–5 CKD group (43%) than in the stages 1–2 CKD (10%) and HD (10%) groups. NVG was more common in the stages 3–5 CKD group (17%) than in the stages 1–2 CKD (2%) and HD (0%) groups. The reduced estimated glomerular filtration rate (eGFR) was the only significant variable associated with post-vitrectomy VH and NVG. Patients with PDR and CKD, particularly those with lower eGFR, might be at risk for post-vitrectomy VH and NVG.
Collapse
|
29
|
Abstract
Eales' disease is an idiopathic vasculitis that affects the peripheral retina. It is characterized by recurrent vitreous hemorrhage as a complication of retinal neovascularization. It is more prevalent in India and affects young males. Here, we present a patient with neovascular glaucoma as a rare first presentation of Eales' disease. This is a 24-year-old Indian male, who complained of a sudden decrease in vision in the left eye over less than 24 hours, along with frontal headache and eye pain for the last three weeks. Ocular examination revealed peripheral retinal ischemia in the right eye, very high intraocular pressure, rubeosis iridis, vitreous hemorrhage and extensive retinal ischemia in the left eye, vascular sheathing and neovascularization in both eyes. The purified protein derivative skin test was positive. The patient was managed with anti-glaucoma, intravitreal anti-vascular endothelial growth factor and laser photocoagulation. Systemic steroids and anti-tuberculous therapy were also initiated. Neovascular glaucoma is an infrequent complication of Eales' disease. However, the lack of early detection of the disease in the early stages might lead to such serious complications.
Collapse
|
30
|
AlRubaie K, Albahlal A, Alzahim T, Edward DP, Kozak I, Khandekar RB. Neovascular Glaucoma Progress and Impact of Therapeutic Intervention in Saudi Arabia. Cureus 2021; 13:e17696. [PMID: 34650870 PMCID: PMC8489598 DOI: 10.7759/cureus.17696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: This study aimed to present the outcomes of the therapeutic interventions for neovascular glaucoma (NVG) between 2002 and 2012 at a tertiary eye hospital in Saudi Arabia. Methods: A retrospective chart review of the patients with NVG treated in the last 10 years at King Khaled Eye Specialist Hospital was carried out. The demographics, visual acuity, and intraocular pressure (IOP) at the baseline were compared to that, at last, follow-up. The clinical course of treated eyes and causes for poor vision were reviewed. Results: Among 597 eyes with NVG, the mean IOP at presentation was 32 mmHg. A total of 335 eyes (56.1%) were treated with pan-retinal photocoagulation (PRP). In 459 (77%) eyes, IOP was controlled with medications or different surgeries. The vision on the last follow-up was 20/20 to 20/40 in 19 (3%) eyes, 20/50 to 20/200 in 67 (11%) eyes, <20/200 to 20/400 in 267 (45%) eyes, and <20/400 in 225 (38%) eyes. Nineteen eyes were soft/enucleated. In 45 (8%, 95% CI 6-10) eyes vision improved. The IOP was reduced to <22 mmHg in 369 (62%, 95% CI 58.2-65.9) eyes, 23-30 mmHg in 69 (12%) eyes and was > 31 mmHg in 102 (17%) eyes. In 26 (3.7%) eyes, ocular hypotony was noted. The causes of poor vision included retinal ischemia (n=75, 13%), optic nerve head cupping (n=104, 17%), retinal detachment (n= 42, 7%) and other (n=17, 3%). Conclusion: The NVG is a serious ocular ischemic complication. Prompt therapy maintained or improved the vision and controlled IOP in 50% and more cases.
Collapse
Affiliation(s)
- Khalid AlRubaie
- Vitreoretinal Surgery, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | - Abdullah Albahlal
- General Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | - Tariq Alzahim
- General Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | - Deepak P Edward
- Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, USA
| | - Igor Kozak
- Retina, Moorfields Eye Hospital, Abu Dhabi, ARE
| | - Rajiv B Khandekar
- Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, CAN.,Epidemiology and Public Health, King Khaled Eye Specialist Hospital, Riyadh, SAU
| |
Collapse
|
31
|
Hwang HB, Lee NY. Effect of anti-vascular endothelial growth factor on the surgical outcome of neovascular glaucoma: An overview and meta-analysis. Medicine (Baltimore) 2021; 100:e27326. [PMID: 34596134 PMCID: PMC8483822 DOI: 10.1097/md.0000000000027326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Bevacizumab is known to be very effective in inhibiting ocular neovascularization in neovascular glaucoma (NVG). The purpose of this study is to evaluate the effect of anti-vascular endothelial growth factor on the surgical outcome of Ahmed glaucoma valve implantation (AGVI) in NVG. METHODS An extensive search of PubMed, EMBASE, and the Cochrane Library was carried out in January 2021 to select relevant studies. The weighted mean difference of the intraocular pressure reduction percentage from baseline to endpoint was used for the primary efficacy estimate. Mantel-Haenszel odds ratios and 95% confidence intervals (CIs) for success rate were employed as secondary efficacy estimates. The number of postoperative interventions and the tolerability estimate for adverse events were also measured using odds ratios. We conducted meta-analyses of fixed effects models using comprehensive meta-analysis software to pool the results of the included studies. Heterogeneity was assessed using Q-value and I2 measures. RESULTS Nine studies were included in the analysis, encompassing a total of 410 eyes. There was no significant difference in intraocular pressure reduction percentage between the AGVI-only group and the AGVI with adjuvant bevacizumab group (estimate 0.324; 95% CI, -0.278-0.926; P = .244). However, the success rate favored the AGVI with adjuvant bevacizumab group (estimate 0.561; 95% CI, 0.097-1.025, P = .018). CONCLUSIONS AGVI with adjuvant bevacizumab had no significant effect on lowering IOP in patients with neovascular glaucoma compared with AGVI alone. However, the final success rate was higher for AGVI with adjuvant bevacizumab treatment than with AGVI alone.
Collapse
Affiliation(s)
- Hyung Bin Hwang
- Department of Ophthalmology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Na Young Lee
- Department of Ophthalmology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| |
Collapse
|
32
|
Dumbrăveanu L, Cușnir V, Bobescu D. A review of neovascular glaucoma. Etiopathogenesis and treatment. Rom J Ophthalmol 2021; 65:315-329. [PMID: 35087972 PMCID: PMC8764420 DOI: 10.22336/rjo.2021.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
Neovascular glaucoma (NVG) is a type of secondary glaucoma, refractory to treatment, often incurable, with very poor visual prognosis. It is characterized by the appearance of new vessels over the iris and iridocorneal angle and frequently associates the presence of a fibrovascular membrane which limits the aqueous humor outflow from the anterior chamber. The most common causes of NVG are: central retinal vein occlusion, proliferative diabetic retinopathy, and ocular ischemic syndrome. Once the gonioscopy developed as a part of clinical examination, it became possible to visualize the new vessels of the anterior segment of the eye in early stages and to understand the mechanisms of increased intraocular pressure (IOP), including narrowing and closing of the iridocorneal angle. Also, the modern imaging techniques, such as optical coherence tomography angiography and fluorescein angiography became indispensable for the clinician. Thus, an early diagnosis, followed by starting an appropriate therapy: panretinal photocoagulation or administration of anti-VEGF drugs, with or without hypotensive ocular therapy, allows the preservation of visual functions for patient's better quality of life. However, one or more surgeries will often be required, especially in the advanced stages of the disease, which do not respond to drug therapy. Managing the NVG we should aim to: 1) reduce ocular ischemia and treat its underlying cause, 2) reduce elevated IOP, once installed and 3) control the inflammatory process. Anyway, the best treatment is prevention, so we must be very attentive at patients with risk factors for developing the NVG. Abbreviations: NVG = neovascular glaucoma, ICA = iridocorneal angle, IOP = intraocular pressure, TM = trabecular meshwork, AH = aqueous humor, AC = anterior chamber, PRP = panretinal photocoagulation, VEGF = vascular endothelial growing factor, Anti-VEGF = anti- vascular endothelial growing factor, PAS = peripheral anterior synechiae, CRVO = central retinal vein occlusion, PDR = proliferative diabetic retinopathy, DR = diabetic retinopathy, OIS = ocular ischemic syndrome, CRAO = central retinal artery occlusion, ROP = retinopathy of prematurity, FEVR = familial exudative vitreoretinopathy, PVR = proliferative vitreoretinopathy, MMPs = matrix metalloproteinases, VEGFR = vascular endothelial growing factor receptor, PDGF = platelet-derived growth factor, PIGF = placental growth factor, NRP = neuropilins, HIF = hypoxia-inducible factor, SDF1 = stromal cell-derived factor 1, DDL4 = delta like ligand 4, NICD = Notch intracellular domain, TIMMPs = tissue inhibitors of matrix metalloproteinases, ANGPT = angiopoietin, Tie 2 = tyrosine-protein kinase receptor for angiopoietins, IGF-1 = insulin-like growth factor 1, RPE = retinal pigment epithelium, IL = interleukin, TNF = tumor necrosis factor, bFGF = basic fibroblast growth factor, TGF = transforming growth factor, HGF = hepatocyte growth factor, TNFR 2 = tumor necrosis factor receptor 2, OIR = oxygen induced retinopathy, NVI = neovascularization of the iris, NVA = neovascularization of the iridocorneal angle, FA = fluorescein angiography, RAPD = relative afferent pupillary defect, CNP = capillary non-perfusion, NVE = neovascularization elsewhere in the retina, NVD = neovascularization of the optic disc, FFA = fundus fluorescein angiography, OCTA = optical coherence tomography angiography, B-scan US = B-scan ocular ultrasound, AS-OCT = anterior segment optical coherence tomography, ARC = anterior retinal cryotherapy, FDA = food and drug administration, United States of America, BVZ = bevacizumab, RBZ = ranibizumab, AFB = aflibercept, AMD/ ARMD = age related macular degeneration, DME = diabetic macular edema, GDDs = glaucoma drainage devices, MMC = mitomycin C, 5-FU = 5-fluorouracil, AGV = Ahmed glaucoma valve, AADI = Aurolab aqueous drainage implant, MIGS = minimally invasive glaucoma surgery, BCVA = best corrected visual acuity, TVT = Tube versus Trabeculectomy study, MPC = micro-pulse cyclophotocoagulation.
Collapse
Affiliation(s)
- Lilia Dumbrăveanu
- Department of Ophthalmology and Optometry, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Valeriu Cușnir
- Department of Ophthalmology and Optometry, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Doina Bobescu
- Department of Ophthalmology and Optometry, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| |
Collapse
|
33
|
Malgi VS, Gawas L, Iyer AS, Rao A. Clinical profile and outcomes of neovascular glaucoma in the era of anti-vascular endothelial growth factor. Indian J Ophthalmol 2021; 69:2728-2733. [PMID: 34571623 PMCID: PMC8597518 DOI: 10.4103/ijo.ijo_528_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To report the clinical profile and visual impairment in various stages of neovascular glaucoma (NVG) at a tertiary eye center in East India. Methods: The electronic medical records of the hospital database of patients with neovascular glaucoma seen between 2013 and 2020 were reviewed. Gonioscopic details were used to stratify patients into nonspecified NVG (Group 1), open-angle NVG (Group 2), and closed-angle NVG (Group 3). The clinical profile, angle features, cause of NVG, systemic associations, visual impairment, and blindness (defined as logarithm of the minimum angle of resolution, LogMar >1.3 at baseline and at final follow-up), and outcomes of medical/surgical interventions were compared between the three groups. Results: Of 846 eyes of 810 patients with NVG (Group 1, n = 564 eyes, Group 2, n = 61 eyes, and Group 3, n = 220 eyes), at baseline, the blindness rates in Groups 3 and 2 were 90 and 75%, respectively. The time from a previous intervention to the onset of NVG ranged from 3 to 5 months, while the median duration of NVG was about 4–4.5 months (0.03–120 months). Multivariate regression identified a longer duration of NVG as the only variable associated with poor final visual acuity. Conclusion: Visual morbidity by NVG remains as high as 75–90% in developing countries, even with the availability of anti-VEGFs and after improved management/investigative at all stages.
Collapse
Affiliation(s)
| | - Lisika Gawas
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Archana Suresh Iyer
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Aparna Rao
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| |
Collapse
|
34
|
Tsai YE, Hsu CR. Ocular Decompression Retinopathy after Anterior Chamber Paracentesis for Neovascular Glaucoma. Medicina (Kaunas) 2021; 57:medicina57101038. [PMID: 34684075 PMCID: PMC8537183 DOI: 10.3390/medicina57101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
Ocular decompression retinopathy (ODR) is a rare complication associated with intraocular pressure (IOP)-lowering interventions. We report a case of neovascular glaucoma in the left eye with marked IOP elevation (33 mmHg in the left eye). The IOP in the left eye did not improve despite medical treatment. Paracentesis of the left eye was then performed, and the IOP in the left eye decreased to 9 mmHg. One day after the procedure, several intraretinal hemorrhages, Roth spots, and subhyaloid hemorrhages appeared in the fundus of the left eye. Left eye retinopathy was likely ODR because of the rapid decline in IOP.
Collapse
Affiliation(s)
- Yung-En Tsai
- Department of Ophthalmology, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan;
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Cherng-Ru Hsu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-972-313-173; Fax: +886-774-052-31
| |
Collapse
|
35
|
Bernal-Morales C, Dotti-Boada M, Olate-Perez A, Navarro-Angulo MJ, Pelegrín L, Figueras-Roca M. Simultaneous pars plana vitrectomy, panretinal photocoagulation, cryotherapy, and Ahmed valve implantation for neovascular glaucoma. Int J Ophthalmol 2021; 14:1396-1401. [PMID: 34540616 DOI: 10.18240/ijo.2021.09.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Carolina Bernal-Morales
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona 08028, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08028, Spain
| | - Marina Dotti-Boada
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona 08028, Spain
| | - Alvaro Olate-Perez
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona 08028, Spain
| | | | - Laura Pelegrín
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona 08028, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08028, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona 08028, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08028, Spain
| |
Collapse
|
36
|
Tanke LB, Chodnicki KD, Olsen TW, Bhatti MT, Chen JJ. Population-Based Incidence of Ocular Neovascularization Following Central Retinal Artery Occlusion in Olmsted County, Minnesota. Clin Ophthalmol 2021; 15:3531-3537. [PMID: 34456558 PMCID: PMC8387312 DOI: 10.2147/opth.s327704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the population-based incidence of ocular neovascularization (NV) following central retinal artery occlusion (CRAO) and systemic risk factors associated with its development. Methods Diagnosis of CRAO between January 1, 1976, and September 9, 2016, was identified using the Rochester Epidemiology Project, a medical records linkage system for all medical care provided to residents of Olmsted County, Minnesota. Records were reviewed to confirm the diagnosis of CRAO, and data were collected on ocular NV and associated systemic diseases. Results There were 89 patients with CRAO. Subsequent ocular neovascularization developed in 14 (16%) patients. Neovascularization of the iris (NVI) was present in 9/14 (64%) of these patients, neovascularization of the angle (NVA) in 10/14 (71%), neovascularization of the disc (NVD) in 2/14 (14%), and neovascularization elsewhere (NVE) in 1/14 (7%). Of these 14 patients with NV, 9 (64%) developed neovascular glaucoma (NVG). The mean time from CRAO diagnosis to NV was 82 days (range 22 to 268 days). Excluding the patients with proliferative diabetic retinopathy or CRAO caused by CRVO, the mean time to NV diagnosis was 80 days and the shortest time to NV diagnosis was 22 days. Diabetes mellitus was present in 64% of those with NV compared to 23% of those without NV (P = 0.003). Conclusion The population-based incidence of ocular neovascularization following CRAO is 16% and developed within 2 months in half the cohort. Patients with diabetes mellitus are at increased risk for NV complications.
Collapse
Affiliation(s)
- Laurel B Tanke
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | | | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - M Tariq Bhatti
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
37
|
Sharma M, Yangzes S, Singh SR, Dogra M. Bilateral Diffuse Uveal Melanocytic Proliferation in a Patient with Recurrent Frontal Lobe Meningioma. Ocul Immunol Inflamm 2021; 30:1172-1175. [PMID: 34424118 DOI: 10.1080/09273948.2020.1859550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Bilateral diffuse uveal melanocytic proliferation (B-DUMP) is a paraneoplastic disorder that may be seen in patients with a known malignancy but more commonly is seen in those without any history of cancer. It leads to multiple uveal tumors with exudative retinal detachment along with thickening of the choroid and generally carries a poor prognosis. Its etio-pathogenesis is poorly understood but is said to involve factors secreted by the systemic malignancy that lead to proliferation of melanocytes in the uvea.Methods: We report the presentation and management of a female with history of treated frontal lobe meningioma who presented with neovascular glaucoma along with B-DUMP and was found to have recurrence of the meningioma on neuro-imaging.Conclusions: Central nervous system meningiomas can cause B-DUMP and management of the malignancy may lead to partial resolution of posterior segment manifestations of B-DUMP.
Collapse
Affiliation(s)
- Manu Sharma
- Health and Family Welfare Department, Civil Hospital Kangra, Kangra, India
| | - Sonam Yangzes
- Anterior segment and Cornea Service, Grewal Eye Institute, Chandigarh, India
| | - Simar Rajan Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
38
|
Hase K, Kase S, Kanda A, Shinmei Y, Noda K, Ishida S. Expression of Vascular Endothelial Growth Factor-C in the Trabecular Meshwork of Patients with Neovascular Glaucoma and Primary Open-Angle Glaucoma. J Clin Med 2021; 10:jcm10132977. [PMID: 34279462 PMCID: PMC8267742 DOI: 10.3390/jcm10132977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
To investigate the expression of vascular endothelial growth factor (VEGF)-C and vascular endothelial growth factor receptor (VEGFR)3 in the trabecular meshwork (TM) of patients with glaucoma and cultured TM cells. Methods: The expressions of VEGF-C in angle tissues collected by trabeculectomy from patients with glaucoma and non-glaucomatous choroidal malignant melanoma were analyzed by immunohistochemistry. Additionally, VEGF-C concentrations were determined in the aqueous humor of patients with glaucoma by ELISA. The expressions of VEGFR3, which is a receptor of VEGF-C in cultured TM cells, were analyzed by Western blot analysis and immunocytochemistry. Cultured TM cells were stimulated by oxidative stress, hypoxia, or high glucose conditions, and VEGF-C concentrations in supernatants and cell lysates were determined by ELISA. Results: VEGF-C immunoreactivity was positive in TM tissues of glaucoma patients, but not in those of non-glaucomatous controls. VEGF-C concentrations in the aqueous humor of patients with neovascular glaucoma and primary open-angle glaucoma were lower than those with non-glaucoma patients. VEGFR3 was expressed in cultured TM cells. VEGF-C concentrations in supernatants or cell lysates of TM cells cultured under oxidative stress and hypoxia were significantly elevated compared with those under steady conditions (p < 0.05). VEGF-C concentrations in supernatants and cell lysates of TM cells cultured in high glucose were significantly higher than those in low glucose (p < 0.01). Conclusions: VEGF-C was expressed in TM tissues of patients with glaucoma, which was secreted from cultured TM cells under various pathological conditions. These results suggest that VEGF-C may be involved in the pathology of glaucoma.
Collapse
Affiliation(s)
| | - Satoru Kase
- Correspondence: ; Tel.: +81-11-706-5944; Fax: +81-11-706-5948
| | | | | | | | | |
Collapse
|
39
|
Abstract
PURPOSE To report the incidence and clinical features of neovascular complications from cytomegalovirus (CMV) necrotizing retinopathy in patients after haploidentical hematopoietic stem cell transplantation. METHODS Thirty-nine patients (58 eyes) of CMV necrotizing retinopathy after haploidentical hematopoietic stem cell transplantation in our institute between January 2018 and June 2020 were retrospectively reviewed, and cases that developed neovascular complications during follow-up were identified and described. RESULTS Two (2 eyes) cases that developed neovascular glaucoma from CMV necrotizing retinopathy were identified. Both of them manifested as granular peripheral retinitis, panretinal occlusive vasculitis, and some degree of intraocular inflammation, which were consistent with chronic retinal necrosis. Insidious progression of isolated immune-mediated occlusive vasculitis that could only be observed on fundus fluorescein angiography without active retinitis or intraocular inflammation was recognized to be the cause in one of two cases. CONCLUSION Neovascular glaucoma developed in 5.1%/cases and 3.4%/eyes complicated by CMV chronic retinal necrosis and vasculitis in patients after haploidentical hematopoietic stem cell transplantation, which warrants the needs for long-term follow-up. Immune-mediated CMV vasculitis could be an isolated manifestation in patients with a minimal immune deviation and may only be found on fundus fluorescein angiography, which emphasizes the importance of fundus fluorescein angiography on a regular basis during follow-up.
Collapse
Affiliation(s)
- Ze Long
- Department of Ophthalmology and Clinical Center of Optometry, Peking University People's Hospital, Beijing, China
- Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China; and
- College of Optometry, Peking University Health Science Center, Beijing, China.
| | - Jing Hou
- Department of Ophthalmology and Clinical Center of Optometry, Peking University People's Hospital, Beijing, China
- Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China; and
- College of Optometry, Peking University Health Science Center, Beijing, China.
| | - Heng Miao
- Department of Ophthalmology and Clinical Center of Optometry, Peking University People's Hospital, Beijing, China
- Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China; and
- College of Optometry, Peking University Health Science Center, Beijing, China.
| |
Collapse
|
40
|
Călugăru D, Călugăru M. Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions. Int J Ophthalmol 2021; 14:931-935. [PMID: 34150550 DOI: 10.18240/ijo.2021.06.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
Intraocular pressure (IOP) modifications in patients with acute central/hemicentral retinal vein occlusions (RVOs) consist in IOP reductions and increases. The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor, that increases gradually until 3mo after the venous occlusion onset, and then finally disappears after month 4th. The IOP increases lead to the ocular hypertension and glaucoma. The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups: 1) the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis; 2) the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance (ocular hypertension, primary angle-closure, primary angle-closure glaucoma, and open angle glaucomas); and 3) the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations, lacking a causal connection between the 2 conditions.
Collapse
Affiliation(s)
- Dan Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca 400467, Romania
| | - Mihai Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca 400467, Romania
| |
Collapse
|
41
|
Al Sarireh F, Alrawashdeh HM, Al Zubi K, Al Salem K. Role of bevacizumab intraocular injection in the management of neovascular glaucoma. Int J Ophthalmol 2021; 14:855-859. [PMID: 34150540 DOI: 10.18240/ijo.2021.06.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the long-term effects of intraocular bevacizumab (Avastin) injections as an adjunctive drug to manage patients with neovascular glaucoma (NVG). METHODS A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy (n=25), ischemic central retinal vein occlusion (n=8), and retinal ischemia resulting from persistent detachment (n=1) were managed by intraocular injections of bevacizumab (1.25 mg/0.05 mL), in addition to other treatments. The main outcome measure was the change in the degree of iris neovascularization. Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection. RESULTS All patients were followed-up for at least 12mo. At the last follow-up, complete regression of rubeosis irides was detectable in 13 (38.2%) eyes and incomplete regression in 21 eyes (61.8%). The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit (P=0.000005). Patients received an average of 4.97 injections. As additional treatments, 12 eyes (35%) received laser photocoagulation and 6 eyes (18%) underwent retinocryopexy. No further treatment was needed in 16 eyes (47.1%). CONCLUSION Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures. The primary cause of retinal ischemia should be always targeted.
Collapse
Affiliation(s)
- Fawaz Al Sarireh
- Department of Ophthalmology, College of Medicine, University of Mutah, Karak 61710, Jordan
| | | | - Khalid Al Zubi
- Department of Ophthalmology, College of Medicine, University of Mutah, Karak 61710, Jordan
| | - Khalil Al Salem
- Department of Ophthalmology, College of Medicine, University of Mutah, Karak 61710, Jordan
| |
Collapse
|
42
|
Talaat K, Fathi OT, Alamoudi SM, Alzahrani MG, Mukhtar RM, Khan MA. Types of Glaucoma and Associated Comorbidities Among Patients at King Abdulaziz Medical City, Jeddah. Cureus 2021; 13:e15574. [PMID: 34277196 PMCID: PMC8270073 DOI: 10.7759/cureus.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 10/27/2022] Open
Abstract
Aim To identify the types of glaucoma and associated comorbidities among patients attending the ophthalmology clinic at King Abdulaziz Medical City (KAMC) in Jeddah. Methods A cross-sectional study that included all glaucoma patients at KAMC in Jeddah between June 1st, 2016 and November 30th, 2020. Data were collected through retrospective chart review from the electronic medical record system (BestCare) and utilized a structured data collection sheet. Results A total of 283 patients met the inclusion criteria. The most common type was primary open-angle glaucoma (POAG; 53%) followed by secondary glaucomas (SG; 26.5%) then childhood glaucoma and primary angle-closure glaucoma (CG, PACG; 7.4%). The majority of secondary glaucoma cases were due to neovascular glaucoma (NVG; 44.9%), followed by phacomorphic glaucoma (17.9%) and phacolytic glaucoma (10.3%). Hypertension (60.8%) and diabetes (58.3%) were the most prevalent systematic comorbidities, and cataract (49.1%) was the most prevalent ocular comorbidity. Conclusion POAG was the most common glaucoma type, followed by SG, CG, and PACG. Among secondary glaucoma types, neovascular glaucoma was found to be the most common subtype. Hypertension was the most prevalent comorbid condition.
Collapse
Affiliation(s)
- Karim Talaat
- Vitreoretinal Surgery - Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs / King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Obada T Fathi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Saeed M Alamoudi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Muhanad G Alzahrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rayan M Mukhtar
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Muhammad A Khan
- Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Research, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Abdulaziz Medical City, Jeddah, SAU
| |
Collapse
|
43
|
Husain KA, Alaali H, Alderazi H. Early Surgical Intervention for Neovascular Glaucoma in a Patient with Diabetes. Cureus 2021; 13:e15420. [PMID: 34113524 PMCID: PMC8177024 DOI: 10.7759/cureus.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Khatoon A Husain
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
| | - Haneen Alaali
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
| | - Husain Alderazi
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
| |
Collapse
|
44
|
Chemello F, Rodella A, Barosco G, Ceruti P, Tosi R, Marchini G. Double versus single suture stenting to manage hypertensive spikes after glaucoma drainage device implantation. Eur J Ophthalmol 2021; 31:3542-3548. [PMID: 33938321 DOI: 10.1177/11206721211014386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of double compared to single intraluminal suture stenting in reducing early postoperative hypertensive spikes (HS) and hypotony after Baerveldt glaucoma implant surgery. METHODS For this retrospective study, we reviewed the medical charts of 60 patients (60 eyes) who underwent Baerveldt drainage device surgery between 2017 and 2019. Two groups were formed according to whether a single suture stent was placed within the tube (5-0 polypropylene, 30 eyes, group 1) or a double suture (5-0 and 6-0 polypropylene, 30 eyes, group 2). Intraocular pressure (IOP) was measured at baseline, at 6 h, and on postoperative days 1, 2, 5, 7, 14, 21, 30, 60, 90, 180. The occurrence of HS (IOP ⩾ 30 mmHg), anterior chamber reformation, decompressive paracentesis, anti-glaucoma medication, and adverse events were recorded. RESULTS There was a greater decrease in IOP from baseline at days 1, 2, and 21 (p < 0.05) and number of HS at 6 h (p = 0.006) and postoperative day 1 (p < 0.001) in group 2. The mean number of decompressive paracentesis, anterior chamber reformation procedures, and topical anti-glaucoma medications was the same in both groups; the need for oral acetazolamide was significantly lower in group 2 at days 1, 21, and 30 (p < 0.05). CONCLUSIONS While both stenting methods provide a gradual, controlled decrease in IOP, the double stenting technique was associated with a sooner and greater postoperative reduction in IOP and a good safety profile thanks to fewer HS in the early postoperative period and less need for oral acetazolamide.
Collapse
Affiliation(s)
- Francesca Chemello
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Anna Rodella
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Guido Barosco
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Piero Ceruti
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Roberto Tosi
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Giorgio Marchini
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| |
Collapse
|
45
|
Arpa P, Arpa C. Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony. Eur J Ophthalmol 2021; 31:2759-2764. [PMID: 33892596 DOI: 10.1177/11206721211012200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the application of a modified Ahmed glaucoma valve (AGV) surgical implantation technique in vitrectomized eyes, in order to minimize the risk of early postoperative hypotony, which leads to hemorrhagic complications. MATERIALS AND METHODS Data of patients implanted with AGV using the surgical technique described were retrospectively reviewed. Inclusion criterion: glaucomatous eyes with previous history of pars plana vitrectomy. Intraocular pressure (IOP) measurement and ophthalmic examination were performed preoperatively and postoperatively weekly for 1 month for the detection of early hypotony, choroidal effusion/detachment, intraocular hemorrhage. The surgical technique consisted in creating a 5 mm long scleral tunnel with a 23 G needle reaching the anterior chamber at the iridocorneal angle, in which the Ahmed glaucoma valve tube was inserted. RESULTS Ten eyes of 10 patients were included. Median preoperative IOP was 30.5 mmHg [interquartile range (IQR) 28.3-33.0]; median postoperative IOP was 12.0 mmHg (IQR 9.3-13.0) at 1 week, and 12.5 mmHg (IQR 11.0-15.0) at 1 month. In no cases postoperative IOP was <8 mmHg. On the first postoperative day, five (50%) eyes showed few blood clots in the anterior chamber. On the second-week appointment, moderate choroidal effusion was observed in two eyes (20%). No hemorrhagic complications were observed. CONCLUSIONS The creation of a long intrascleral tunnel with a 23 G needle for AGV implantation in vitrectomized eyes could be effective in decreasing leakage through the space between the valve tube and the sclerocorneal tissue. This technique is safe, easy to perform, feasible and fast. Due to its advantages and good postoperative results, it could also be adopted in non-vitrectomized eyes.
Collapse
Affiliation(s)
- Paolo Arpa
- Vimercate Hospital (ASST di Vimercate), Monza-Brianza, Italy
| | - Cristina Arpa
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
46
|
Maki H, Mori S, Imai H, Yamada H, Otsuka K, Miki A, Kusuhara S, Nakamura M. Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma. J Clin Med 2021; 10:jcm10081606. [PMID: 33920094 PMCID: PMC8068818 DOI: 10.3390/jcm10081606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
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.
Collapse
|
47
|
Bai L, Tariq F, He YD, Zhang S, Wang F. Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade. Int J Ophthalmol 2021; 14:456-460. [PMID: 33747825 PMCID: PMC7930538 DOI: 10.18240/ijo.2021.03.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma (NVG) after vitrectomy with silicone oil tamponade. METHODS Conbercept 0.5 mg/0.05 mL was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation (PRP) or extra-PRP were conducted within 2d. The follow-up time was 6mo. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), neovascularization of iris (NVI) were recorded before and after treatment. RESULTS Within 2d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.
Collapse
Affiliation(s)
- Ling Bai
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Farheen Tariq
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Yi-Dan He
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
- Department of Geriatric Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Feng Wang
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| |
Collapse
|
48
|
Ducloyer J, Bensaber S, Khanna RK, Cochard C, Lebreton O, Le Meur G, Lebranchu P, Arsene S, Weber M. Predictive values of initial semi-quantitative assessment of relative afferent pupillary defect for neovascularization in central retinal vein occlusion. Acta Ophthalmol 2021; 99:215-220. [PMID: 32701208 DOI: 10.1111/aos.14544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure the predictive values of relative afferent pupillary defect (RAPD) assessed semi-quantitatively, and visual acuity (VA) at onset of central retinal vein occlusion (CRVO), for neovascularization. METHODS Retrospective analysis of the TROXHEMO trial that included patients with CRVO within 30 days after the onset. Inclusion criteria were as follows: semi-quantitative RAPD assessment at diagnosis and/or at one month. RAPD was 'severe' if ≥ 0.9 log. Exclusion criteria were as follows: prophylactic panretinal photocoagulation (PRP) before neovascularization. RESULTS Among the 119 patients enrolled in the main centre, 101 were analysed. 26 had a neovascular complication during the twelve months of follow-up: rubeosis (19), glaucoma (7) and posterior neovascularization (15). The mean time to onset of a neovascular complication was 4.7 months (1 to 12, median 3 months). All the patients who had a neovascular complication had RAPD at first examination or at one month (negative predictive value (NPV) = 100%) but the positive predictive value (PPV) was low (31%, 95% CI [21%; 42%]). The association 'severe RAPD or VA < 35 letters (ETDRS) at inclusion or at one month' was the best compromise between PPV (53%, [39%; 68%]) and NPV (96%, [92%; 100%]). CONCLUSION To predict neovascularization, RAPD should be routinely evaluated with filters: the risk of neovascular complication is (a) almost nil if there is no RAPD, (b) very low if there is no severe RAPD and if VA is higher than 35 letters, and (c) higher than 50% if RAPD is ≥ 0.9 log or if VA is less than 35 letters.
Collapse
Affiliation(s)
| | - Sonia Bensaber
- Department of Ophthalmology University Hospital of Nantes Nantes France
| | | | - Catherine Cochard
- Department of Ophthalmology University Hospital of Rennes Rennes France
| | - Olivier Lebreton
- Department of Ophthalmology University Hospital of Nantes Nantes France
| | - Guylène Le Meur
- Department of Ophthalmology University Hospital of Nantes Nantes France
| | - Pierre Lebranchu
- Department of Ophthalmology University Hospital of Nantes Nantes France
| | - Sophie Arsene
- Department of Ophthalmology University Hospital of Tours Tours France
| | - Michel Weber
- Department of Ophthalmology University Hospital of Nantes Nantes France
| |
Collapse
|
49
|
Márquez MA, Juárez CP, Sánchez MC, Luna JD. Rubeosis iridis and macular hemorrhages from multiple Corkscrew retinal vessels in a patient with NF1. Eur J Ophthalmol 2021; 32:NP43-NP47. [PMID: 33601906 DOI: 10.1177/1120672121996636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a case of a patient with NF1 presenting with ocular findings of AV malformation, multiple retinal hemorrhages, and neovascular glaucoma in the absence of retinal ischemia. METHODS Review of the medical record was conducted in accordance with the local IRBt. RESULTS A 60-year-old female patient with diagnosis of Neurofibromatosis type1 (NF1) and sudden decrease of vision in her left eye was found to have rubeosis iridis and high intraocular pressure (IOP). On fundus exam multiple corkscrew retinal vessels and retinal hemorrhages were present in her left eye. On Optical Coherence Tomography (OCT) the foveal hemorrhages appeared as outer layer hyperreflective retinal infiltrates whereas in the parafoveal area the hyperreflectivity was present between the RPE and neurosensory retina. Fluorescein Angiogram (FA) showed normal perfusion and no areas of leakage or ischemia. Treatment with anti-angiogenics in a timely manner correlated with a good visual outcome. CONCLUSIONS We present a unique patient with NF1, rubeosis iridis, high IOP, and macular hemorrhages from multiple corkscrew retinal vessels in a well perfused retina, who underwent treatment with a single dose of intravitreal Bevacizumab and had an excellent response.
Collapse
Affiliation(s)
| | - Claudio P Juárez
- Vitreo-retinal Department, Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| | - Maria C Sánchez
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jose D Luna
- Vitreo-retinal Department, Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| |
Collapse
|
50
|
Casselholm de Salles M, Lindberg C, Epstein D. Neovascular glaucoma in patients with central retinal vein occlusion: A real-life study in the anti-VEGF era. Acta Ophthalmol 2021; 99:e7-e12. [PMID: 32548981 DOI: 10.1111/aos.14500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the characteristics and treatment patterns of patients developing a neovascular event (NE) in the anterior chamber secondary to central retinal vein occlusion (CRVO) in an ordinary clinical setting. METHODS In this retrospective real-life study, data from 243 eyes presenting with CRVO during 2012-2013 were collected. Maximum follow-up was 5 years. All patients that developed NE were included in the analysis. RESULTS Of 243 eligible patients, 72 (30%) either presented with or developed NE during the follow-up. In these 72 patients, 23 (32%) eyes already had evidence of NE at baseline. Twenty-eight eyes (39%) developed NE after discontinuation of intravitreal therapy for macular oedema (ME). In this subgroup, the NE occurred 15.6 ± 13.8 months after the baseline visit and 4.1 ± 2.6 months after the last injection. Final best-corrected visual acuity was 8.6 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the group of patients presenting with NE compared to 8.1 ETDRS letters in the group that developed NE later on. Of the patients presenting with intraocular pressure (IOP) below 30 mmHg, 3/29 (10%) needed subsequent cyclodiode laser therapy compared to 35/43 (81%) patients with a baseline IOP above 30 mmHg (p < 0.001). CONCLUSIONS In a clinical setting, many patients show evidence of NE already at the first visit. A substantial part of patients develops NE a long time after presentation, commonly a few months after discontinuation of intravitreal therapy for ME. The visual prognosis is similar for patients presenting with NE and patients developing NE during follow-up. A high baseline IOP predicts the need for subsequent pressure-lowering procedures.
Collapse
Affiliation(s)
| | | | - David Epstein
- Karolinska Institutet St. Erik Eye Hospital Stockholm Sweden
| |
Collapse
|