Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study

Abstract Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.

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The incidence and risk factors of neovascular glaucoma secondary to proliferative diabetic retinopathy after vitrectomy

European Journal of Ophthalmology ◽

10.1177/1120672120980686 ◽

2020 ◽

pp. 112067212098068

Author(s):

Difang Sun ◽

Yifan Lin ◽

Rui Zeng ◽

Zhenlan Yang ◽

Xiaowen Deng ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Diabetic Retinopathy ◽

Cataract Surgery ◽

Proliferative Diabetic Retinopathy ◽

Meta Analysis ◽

Vitreous Hemorrhage ◽

Neovascular Glaucoma ◽

Cochrane Library ◽

P Value

Objective: The incidence and risk factors of neovascular glaucoma (NVG) secondary proliferative diabetic retinopathy (PDR) after pars plana vitrectomy (PPV) are unclear and reports in the published literature are inconsistent. Therefore, a systematic review and meta-analysis were conducted to clarify the risk factors associated with neovascular glaucoma. Methods: PubMed, Embase, and The Cochrane Library were systematically searched without language limitations for studies related to NVG after PPV in PDR patients. We used R software to fit the correlation between incidence and the date of publication for studies and performed a Spearman analysis. For binary and continuous variables, the odds ratios (ORs) with 95% confidence intervals (CIs) were pooled, respectively, using Review Manager 5.3 (The Cochrane Collaboration). Results: Twenty-six studies with 5161 patients were included in our meta-analysis. The overall pooled incidence of NVG after PPV in PDR patients was 6% (95% CI, 0.05–0.07, p-value < 0.00001). Pooled estimates indicated a positive correlation for NVG after PPV in PDR patients with higher baseline IOP (OR, 1.26; 95%CI,0.56–1.95, p-value = 0.0004), preoperative iris neovascularization (INV) (OR, 5.66; 95% CI, 2.10–15.23, p-value = 0.0006), preoperative or intraoperative combined cataract surgery (OR, 2.00; 95% CI, 1.15–3.46, p-value = 0.01), postoperative vitreous hemorrhage (VH) (OR, 3.53; 95% CI, 1.63–7.66, p-value = 0.001), and a negative correlation with age (OR, −2.90; 95%CI, −5.00 to −0.81, p-value < 0.007). Conclusion: Our systematic review and meta-analysis indicated that the main risk factors for NVG after PPV in PDR patients included higher baseline IOP, preoperative INV, preoperative or intraoperative combined cataract surgery, postoperative VH, and was negatively correlated with age.

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Severe Neovascular Glaucoma Exacerbation as a Complication of Carotid Artery Stenting: A Case Report

The Neurohospitalist ◽

10.1177/1941874420923914 ◽

2020 ◽

Vol 10 (4) ◽

pp. 301-304

Author(s):

Sishir Mannava ◽

Luis F. Torres ◽

Keith G. DeSousa ◽

Dileep R. Yavagal ◽

Nicolas A. Yannuzzi ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Carotid Artery ◽

Proliferative Diabetic Retinopathy ◽

Carotid Artery Stenting ◽

Pars Plana Vitrectomy ◽

Vitreous Hemorrhage ◽

Cataract Extraction ◽

Neovascular Glaucoma ◽

Pars Plana

Introduction: Neovascular glaucoma (NVG) has been rarely reported as an acute complication of carotid endarterectomy, but there is scant literature available regarding this potential condition following carotid artery stenting (CAS). We present a case of severe worsening of NVG occurring after bilateral CAS with progressive deterioration of vision ultimately leading to blindness. Case Description: A 66-year-old male with multiple stroke risk factors, bilateral cataract extraction, proliferative diabetic retinopathy of left eye, and nonproliferative diabetic retinopathy of right eye, and prior left eye pars plana vitrectomy presented with episodes of transient right eye vision loss in context of bilateral high-grade internal carotid artery stenoses. He underwent right CAS with subsequent elevation of bilateral intraocular pressures (IOPs) concerning for acute NVG. Over time, the patient had some interval improvement in IOPs and underwent planned left CAS. After the procedure, he again developed elevated IOPs, concerning for acute NVG which eventually led to right eye pars plana vitrectomy for vitreous hemorrhage and refractory IOP elevation. At 6-month follow-up from initial stenting, the patient was blind in both eyes. Discussion: We present a case of recurrent IOP elevations following CAS eventually resulting in bilateral eye blindness. This case is important not only as an illustration of an underrecognized postprocedural CAS complication but also as a demonstration of likely elevated risk of NVG following CAS for patients with other predisposing risk factors for ocular hypertension such as glaucoma, proliferative diabetic retinopathy, prior cataract extraction, and prior pars plana vitrectomy.

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Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

Scientific Reports ◽

10.1038/s41598-021-93384-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sung Uk Baek ◽

Min Seon Park ◽

Bum-Joo Cho ◽

In Won Park ◽

Soonil Kwon

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Diabetic Retinopathy ◽

Platelet Count ◽

Multivariate Logistic Regression Analysis ◽

Panretinal Photocoagulation ◽

Lower Baseline ◽

Uncontrolled Diabetes ◽

High Platelet Count ◽

Baseline Visual Acuity

AbstractUncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

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Cost Analysis of Intravitreal Aflibercept vs Vitrectomy With Panretinal Photocoagulation for Vitreous Hemorrhage From Proliferative Diabetic Retinopathy

JAMA Ophthalmology ◽

10.1001/jamaophthalmol.2021.1565 ◽

2021 ◽

Author(s):

Benjamin K. Young ◽

Mark W. Johnson ◽

Thomas J. Wubben

Keyword(s):

Diabetic Retinopathy ◽

Cost Analysis ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Panretinal Photocoagulation ◽

Intravitreal Aflibercept

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Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418764972 ◽

2018 ◽

Vol 2 (3) ◽

pp. 127-137

Author(s):

Dennis M. Marcus ◽

Harinderjit Singh ◽

Davis C. Starnes ◽

Harveen Walia ◽

Amina Farooq ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Panretinal Photocoagulation ◽

Short Term ◽

Safety And Efficacy ◽

Intravitreal Aflibercept ◽

Central Subfield Thickness ◽

Endothelial Growth Factor

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

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Incidence and Risk Factors for Tractional Macular Detachment after Anti-Vascular Endothelial Growth Factor Agent Pretreatment before Vitrectomy for Complicated Proliferative Diabetic Retinopathy

Journal of Clinical Medicine ◽

10.3390/jcm8111960 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1960

Author(s):

Andrea Russo ◽

Antonio Longo ◽

Teresio Avitabile ◽

Vincenza Bonfiglio ◽

Matteo Fallico ◽

...

Keyword(s):

Risk Factors ◽

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Vascular Endothelial ◽

Macular Detachment ◽

Anti Vegf ◽

Endothelial Growth Factor

The study’s purpose was to determine the incidence, risk factors, and outcomes of tractional macular detachment after anti-vascular endothelial growth factor (VEGF) pretreatment before vitrectomy for complicated proliferative diabetic retinopathy. Patients who underwent primary vitrectomy for complicated proliferative diabetic retinopathy, from January 2012 to 31 December 2018, were enrolled. Ophthalmic and pre-operative data were extracted from electronic record systems. All eyes with a valuable Optical Coherence Tomography (OCT)performed within 5 days before injection of anti-VEGF and on the day of vitrectomy were included. Multivariable logistic regression showed that significant risk factors for developing tractional macular detachment included days between anti-VEGF and vitrectomy (OR, 0.71 [95% CI 0.65–0.76]; p < 0.001), vitreous hemorrhage (OR, 0.23 [95% CI 0.11–0.49]; p < 0.001), and age (OR, 1.05 [95% CI 1.02–1.08]; p < 0.001). Decision-tree analysis showed that the stronger predictors of tractional macular detachment were the time between anti-VEGF injection and vitrectomy (p < 0.001). Secondary predictors were the presence of vitreous hemorrhage (p = 0.012) in eyes that underwent vitrectomy between 6 and 10 days after anti-VEGF injection and younger age (p = 0.031) in eyes that underwent vitrectomy 10 days after anti-VEGF injection. Tractional macular detachment occurs in 10% of eyes after anti-VEGF injection, the main risk factors being days between anti-VEGF injection and vitrectomy, vitreous hemorrhage, and age.

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A Case of Proliferative Diabetic Retinopathy with HIV Infection in Which HAART Possibly Influenced the Prognosis of Visual Function

Case Reports in Ophthalmology ◽

10.1159/000452789 ◽

2016 ◽

Vol 7 (3) ◽

pp. 517-522 ◽

Cited By ~ 1

Author(s):

Takakuni Kitagaki ◽

Takaki Sato ◽

Junko Hirai ◽

Daisaku Kimura ◽

Keigo Kakurai ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Hiv Infection ◽

Proliferative Diabetic Retinopathy ◽

Visual Function ◽

Pneumocystis Carinii ◽

Vitreous Hemorrhage ◽

Neovascular Glaucoma ◽

Visual Disturbance ◽

Progression Rate ◽

The Right

Background: We report on a patient with proliferative diabetic retinopathy (PDR) and human immunodeficiency virus (HIV) infection who exhibited extremely active PDR followed by a rapid onset of blindness in the right eye. The progression of visual disturbance in the patient’s left eye was slowed after starting highly active anti-retroviral therapy (HAART), and vision in that eye was rescued after vitrectomy. Case Report: A 72-year-old male developed pneumocystis carinii pneumonia stemming from an HIV infection and began HAART at the Department of Hematology, Osaka Medical College, Takatsuki City, Japan. Prior to HAART, the patient had shown rapidly progressing retinopathy in the right eye accompanied by vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma, ultimately leading to early-onset blindness. After starting HAART, the progression of the retinopathy in the left eye became slower compared to the right eye, with corrected visual acuity improving to 0.6 after vitrectomy, despite being accompanied by vitreous hemorrhage. The patient’s overall condition has remained stable following the operation, and the condition of the ocular fundus in the left eye has also settled. Conclusion: Significant differences were found in the progression rate of PDR with HIV infection between before and after starting HAART. Our findings suggest that early administration of HAART to HIV patients with diabetic retinopathy is crucial for maintaining visual function.

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Risk Factors Associated With Progression of Diabetic Retinopathy in Eyes Treated With Panretinal Photocoagulation

10.21203/rs.3.rs-311086/v1 ◽

2021 ◽

Author(s):

Sung Uk Baek ◽

Min Seon Park ◽

Bum-Joo Cho ◽

In Won Park ◽

Soonil Kwon

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Diabetic Retinopathy ◽

Platelet Count ◽

Multivariate Logistic Regression Analysis ◽

Panretinal Photocoagulation ◽

Lower Baseline ◽

Uncontrolled Diabetes ◽

High Platelet Count ◽

Baseline Visual Acuity

Abstract Uncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). DR patients who had completed PRP in at least one eye with a 3-year follow-up after PRP were included. A total of 243 eyes of 243 subjects (mean age 52.6±11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P=0.019); lower baseline visual acuity (P<0.001); and higher platelet count (P=0.048), hemoglobin (P=0.044), and hematocrit, (P=0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P<0.001) and platelet count (HR: 1.215, P=0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

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