ABSTRACT
Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR).Methods Retrospective study.One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited.There were 85 males and 52 females.The average age was (60.1 ± 8.8) years old.The duration of diabetes was (10.2 ± 3.6) years.There were 49 patients with ipsilateral carotid artery stenosis.Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV.All eyes were treated with 23G standard three-port PPV.The average follow-up time after PPV was 11.5 months.Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas.Risk factors,such as ipsilateral carotid artery stenosis,the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV,were identified by logistic regression.Results Twenty of 137 patients (14.6％) developed postoperative NVG after PPV.Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048,95％ confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274,95％CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG,while the application of anti-VEGF drugs was not (OR=1.426,95％CI 0.463-4.395,P=0.536).But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=-4.370,P=0.000).Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV.The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
ABSTRACT
Background Neovascular glaucoma (NVG) is a refractory disease characterized by neovascularization,and its pathogenesis mechanism is still unelucidated.Researches showed that muhicytokins and inflammatory factors are associated with neovascularization,however,the correlation of these factors with NVG worth attention.Objective This study was to detect the vescular endothelial growth factor (VEGF),transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) levels in aqueous humor and plasma in NVG eyes and its significance.Methods A prospective cases-controlled study was performed under the approval of Ethic Committee of Shanghai East Hospital and informed consent of patients.Eight eyes of 8 NVG patients,10 eyes of 10 primary open angle glaucoma (POAG) patients and 10 eyes of age-related cataract (ARC) patients were entrolled in Shanghai East Hospital from May,2014 to March,2015.The periphery blood of 3-4 ml was collected from all the patients to prepare 0.3-0.4 ml serum,and 0.1-0.2 ml aqueous humor was collected during the surgery from each eye.The aqueous and serum levels of VEGF,TGF-β1 and IL-6 were measured by ELISA.Results The aqueous humor and plasma VEGF concentrations in NVG patients were (2 769.85 ± 390.88) pg/ml and (529.93 ± 95.20) pg/ml,respectively,which were higher than (208.12 ± 58.59) pg/ml and (219.28 ± 24.44) pg/ml in POAG patients as well as (158.88 ±12.35) pg/ml and (172.82±31.91)pg/ml in ARC patients,with significant differences among the three groups (aqueous:F=433.80,P＜0.01;plasma:F=103.84,P＜0.01).The levels of TGF-β1 in aqueous humor and plasma from NVG patients were (157.94±113.00)pg/ml and (3 895.78±2 318.00)pg/ml,showing significant increases in comparison with (54.48±35.58) pg/ml and (2 196.13±1 185.39) pg/ml in the POAG patients or (47.98±17.69) pg/ml and (1937.28±933.27) pg/ml in the ARC patients (aqueous:F =7.88,P＜0.01;plasma:F =4.18,P＜0.05).The concentration of IL-6 in aqueous humor and plasma were (234.87±41.64) pg/ml and (26.97±8.19) pg/ml from NVG patients,with considerable elavation in comparison with (38.97± 19.06)pg/ml and (19.54±5.11)pg/ml in the POAG patients or (29.48±14.61) pg/ml and (18.50±3.57) pg/ml in the ARC patients (aqueous:F =166.27,P＜0.01;plasma:F=5.59,P＜0.05).Conclusions The aqueous and plasma VEGF,TGF-β1 and IL-6 are considerably higher in NVG patients than those in POAG patients and ARC patients,suggesting that these cytokines participate in the pathogenesis and development of the NVG and probably are treating target of NVG.