Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy

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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P-7-4 A study on neovascular glaucoma with proliferative diabetic retinopathy

Diabetes Research and Clinical Practice ◽

10.1016/s0168-8227(87)80120-1 ◽

1987 ◽

Vol 3 ◽

pp. S63

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Neovascular Glaucoma

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Prognostic Factors of Neovascular Glaucoma in Eyes with Treated Proliferative Diabetic Retinopathy

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2017.58.4.415 ◽

2017 ◽

Vol 58 (4) ◽

pp. 415

Author(s):

Ji Hyun Lee ◽

Eun Yeong Kim ◽

Tai Kyong Kim ◽

Hye Young Shin ◽

Su Young Kim ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Prognostic Factors ◽

Proliferative Diabetic Retinopathy ◽

Neovascular Glaucoma

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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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The Measurement of Intraocular Biomarkers in Various Stages of Proliferative Diabetic Retinopathy Using Multiplex xMAP Technology

Journal of Ophthalmology ◽

10.1155/2015/424783 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Stepan Rusnak ◽

Jindra Vrzalova ◽

Marketa Sobotova ◽

Lenka Hecova ◽

Renata Ricarova ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Growth Factor ◽

Proliferative Diabetic Retinopathy ◽

Transforming Growth Factor Beta ◽

Transforming Growth Factor ◽

Neovascular Glaucoma ◽

Clinical Severity ◽

Control Group ◽

Group Number ◽

Xmap Technology

Purpose. To determine the intraocular levels of growth factors and cytokines in patients with various degrees of severity of proliferative diabetic retinopathy (PDR) using multiplex xMAP technology.Methods. A prospective cohort study of 61 eyes from 56 patients who were divided into 3 groups based on the severity of PDR. Patients in group number 1 are those who presented PDR with no need of repeated surgical intervention; patients in group number 2 had repeated vitreous bleeding; and patients in group number 3 had refractory neovascular glaucoma. The concentrations of proangiogenic, antiangiogenic, inflammatory, and neurotrophic factors were measured in intraocular fluid. The results were also compared with levels of factors measured in 50 eyes from 50 patients prior to senile cataract surgery (control group).Results. Patients with refractory neovascular glaucoma (the highest clinical severity group) had higher levels of interleukin 6 (IL-6) (median1 37.19; median3 384.74;P=.00096), transforming growth factor beta 1 (TGFβ-1) (median1 49.00; median3 414.40;P=.0017), and vascular endothelial growth factor (VEGF) (median1 211.62; median3 352.82;P=.0454) compared with other PDR patients.Conclusions. Results of our study imply that levels of IL-6, TGFβ-1, and VEGF correlate with the severity of PDR.

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Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy

PLoS ONE ◽

10.1371/journal.pone.0258415 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258415

Author(s):

Kei Takayama ◽

Hideaki Someya ◽

Hiroshi Yokoyama ◽

Takeshi Kimura ◽

Yoshihiro Takamura ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Postoperative Complications ◽

Proliferative Diabetic Retinopathy ◽

Real World ◽

Postoperative Outcome ◽

Neovascular Glaucoma ◽

Potential Bias ◽

Baseline Hba1c ◽

Anti Vegf ◽

Retinal Breaks

Purpose Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigated factors related to the potential bias of retinal surgeons in using IVI prior to vitrectomy for PDR-related complications, and evaluated the real-world outcomes of surgeon-determined preoperative IVI. Methods Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications. Results At baseline, IVI group was younger (P<0.001), had shorter duration of diabetes treatment (P = 0.045), and higher frequencies of neovascular glaucoma [NVG] (P<0.001) and tractional retinal detachment [TRD] (P<0.001) compared to non-IVI group. Although IVI group had higher frequencies of intraoperative retinal break and tamponade procedure, there were no significant differences in postoperative complications and additional treatments between two groups. Baseline HbA1c levels were also not correlated with postoperative complications of VH, NVG, and RD both in IVI group and non-IVI group. Logistic regression analysis identified age (P<0.001, odds ratio [OR] 0.95), presence of NVG (P<0.001, OR 20.2), and presence of TRD (P = 0.0014, OR 2.44) as preoperative factors in favor of IVI. Conclusions In this multicenter real-world clinical study, younger age and presence of NVG and TRD were identified as potential biases in using IVI before vitrectomy for PDR complications. Eyes that received preoperative IVI had more intraoperative retinal breaks requiring tamponade than eyes not receiving IVI, but postoperative outcome was not different between the two groups.

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