Innovative sequential treatment of neovascular glaucoma / 眼科新进展

ABSTRACT

Objective To observe the curative effects of anti-vascular endothelial growth factor (anti-VEGF) intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope for neovascular glaucoma (NVG).Methods NVG patients with uncontrolled intraocular pressure (IOP) and retinopathy was enrolled from May,2014 to May,2016.Eighteen patients were enrolled with 15 males(15 eyes) and 3 females(3 eyes) with age at (61.7 ± 13.9) years old.Anti-VEGF intracameral and intravitreal injection with anterior chamber puncture was performed in the first day of sequential treatment.Trebeculectomy was performed 3-5 days after injection and finally the pan-retinal photocoagulation was started 5-7 days after anti-glaucoma surgery.The best corrected visual acuity (BCVA),IOP,cornea,neovascularization of iris and retinal disease were observed and recorded.Results The diagnosis included 1 eye with central retinal artery occlusion (CRAO),6 eyes with central retinal vein occlusion (CRVO),5 eyes with branch retinal vein occlusion,5 eyes with proliferative diabetic retinopathy and 2 eyes with combined CRAO and CRVO.IOP before and after treatment were (43.5 ±5.1) mmHg (1 kPa =7.5 mmHg) and (15.2 ± 2.2) mmHg,there was significantly statistical difference (t =21.68,P ＜0.001).The categories of antiglaucoma medicines were 5.1 ± 0.5 and 0.5 ± 1.0 before and after treatment respectively,and the difference was statistical significant (t =12.30,P ＜ 0.001).BCVA was improved in 4 eyes,maintained in 13 eyes and decreased in only 1 eye.Conclusion The sequential treatment including anti-VEGF intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope is safe and effective.