ABSTRACT
Glaucoma drainage implants [GDIs] are used for managing recalcitrant glaucoma and are usually placed in the anterior chamber. This approach may lead to complications such as corneal decompensation, and so a pars plana approach is used in at risk eyes. Aims: To compare functional outcomes and complications of 250 mm 2 and 350 mm 2 pars plana Baerveldt tube insertion with pars plana vitrectomy [PPV] [both 20-and 23-gauge] for managing refractory glaucoma. Settings and Design: A retrospective chart review of 38 patients [39 eyes] undergoing combined PPV-Baerveldt procedure for glaucoma recalcitrant to maximal medical treatment or previous filtering procedures with>6 weeks of follow-up. Main outcome measures were visual acuity, intraocular pressure [IOP], number of glaucoma medications, and postoperative complications. Statistical Analysis Used: A paired 't' test was used to evaluate changes in IOP and glaucoma medications, Fisher's exact test was used to compare complication rates, and Kaplan-Meier survival curves were constructed for comparison of overall outcomes. Mean patient age was 62.2 years. Mean follow-up period was 33.7 months, with 36 [92%] eyes followed for>/=6 months. Mean +/- SD preoperative IOP and number of glaucoma medications were significantly reduced by the combined procedure [P<0.05]. Thirty-five [90%] eyes maintained final IOP between 6 and 21 mmHg. Vision improved by>/=2 lines in 10 [26%] eyes, remained stable in 15 [38%] eyes, and decreased in 14 [36%] eyes. Two [5.1%] eyes developed no light perception vision, with one [2.6%] eye becoming phthisical. Twenty-four [62%] eyes developed complications managed with conservative measures. Five [13%] eyes required>/=1 surgeries within a year of the combined procedure. Pars plana Baerveldt tube implantation with PPV can preserve vision, reduce IOP, and decrease the number of glaucoma medications necessary to achieve target IOP in patients with recalcitrant glaucoma
ABSTRACT
To evaluate the safety of ranibizumab as a surgical adjunct during cataract surgery in patients with proliferative diabetic retinopathy [PDR] with rubeosis, and to evaluate the efficacy and adverse effects of ranibizumab in treating PDR with rubeosis. Three intravitreal injections of 0.5 mg ranibizumab were administered on day-1, months-1 and -2 with cataract surgery 6-16 days after first injection. Retreatments with ranibizumab injections and pan-retinal photocoagulation [PRP] were given if recurrence or persistence of PDR was noted between months-3 and -11. Safety observation visits occurred at months-12, -18 and -24. Primary end points were incidence and severity of adverse events [AEs] that were related to both cataract surgery and treatment of PDR with rubeosis through month -12. Of six patients screened, four [mean age 61.3 years] were enrolled. No AEs were noted with either cataract surgery or treatment of PDR. Neovascularization of iris [NVI] promptly regressed by 4 days after first ranibizumab injection, prior to cataract surgery in three of four patients [one had significantly regressed NVI by post-injection day-3 visit]; NVI was not noted in any patient at 2 weeks after first ranibizumab injection. Recurrence of rubeosis or NVA after 3 monthly injections was not observed in any. At month-12, PDR was not present when assessed clinically and by fluorescein angiogram [FA]. Only one patient developed neovascularization of disc and neovascularization elsewhere and required retreatments at months-5 and -9. Multiple intravitreal injections of ranibizumab may be a safe, effective treatment adjunct for PDR and diabetes-related rubeosis