Chronic Retinal Necrosis Severely Complicated by Neovascular Glaucoma: A Case Report

Background: Chronic retinal necrosis (CRN) is a rare chronic granular necrotizing retinitis that was first described in 2013. CRN is characterized by intraocular inflammation accompanied by occlusive vasculitis, granular retinitis, and slowly progressing necrosis around the retina in a host with partial immune dysfunction. Cytomegalovirus (CMV) is reported to be a causative agent. There are several ocular complications such as retinal detachment and neovascular glaucoma; however, there has been no description of a clinical manifestation of neovascular glaucoma in CRN. We herein present a case of severe neovascular glaucoma in association with CRN. Case Presentation: An 80-year-old man was referred to our hospital with poor control of inflammation and intraocular pressure (IOP). The IOP in his left eye was 29 mm Hg. Anterior chamber cells (2+) and keratic precipitates were observed. In the peripheral retina, vitreous opacities and granular necrotizing retinitis were noticed. Fluorescein angiography revealed extensive retinal nonperfusion area from the macula lesion to the periphery. PCR analysis of aqueous humor showed the presence of CMV. A diagnosis of CRN was made soon afterwards. Antiviral drug and systemic corticosteroid were administered. The treatment temporally resolved the symptom; however, panretinal photocoagulation and intravitreal injection of bevacizumab were performed to treat iris neovascularization. During the follow-up, trabeculectomy was performed because of poor IOP control. At the final visit, severe uncontrolled neovascular glaucoma caused hyphema, and his left eye lost light perception. Conclusion: The prognosis of CRN is poor because of severe neovascular glaucoma and careful observation and active treatments are necessary.

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Aflibercept as Adjunctive Treatment for Filtration Surgery in Neovascular Glaucoma

Siriraj Medical Journal ◽

10.33192/smj.2022.4 ◽

2022 ◽

Vol 74 (1) ◽

pp. 27-33

Author(s):

Naris Kitnarong ◽

Janyawassamon Kittipiriyakul ◽

Anuwat Jiravarnsirikul

Keyword(s):

Neovascular Glaucoma ◽

Additional Treatment ◽

Adjunctive Treatment ◽

Panretinal Photocoagulation ◽

Vein Occlusion ◽

Corrected Visual Acuity ◽

Intravitreal Aflibercept ◽

The One ◽

Ischemic Syndrome

Objective: To investigate intravitreal aflibercept (IVA) injection as an adjunctive treatment to trabeculectomy with mitomycin C (TMC) and panretinal photocoagulation (PRP) for neovascular glaucoma (NVG).Materials and Methods: PRP and IVA (2 mg/0.05 ml) injection were given, and TMC was performed within 2weeks after IVA. Additional PRP, laser suture lysis, subconjunctival 5-fluorouracil injection, and bleb needlingwere performed after TMC if indicated. Best corrected visual acuity (BCVA), intraocular pressure (IOP), surgicalcomplications, and number of anti-glaucoma medications were collected.Results: Five eyes from 5 consecutive patients were included. Two eyes had proliferative diabetic retinopathy (PDR), 2 central retinal vein occlusion, and 1 ocular ischemic syndrome (OIS) (mean initial IOP: 46.8±6.8 mmHg). NVI regression occurred in one eye after PRP alone, and in one eye after PRP and IVA resulting in a good IOP control with topical medical therapy. The other 3 underwent TMC. The preoperative IOP was 34 (OIS), 54 (PDR), and 50 (PDR) mmHg. The 3-month postoperative IOP decreased to 8, 8, and 4 mmHg, respectively, and to 21, 10, and 6 mmHg, respectively, at the last visit. Only the one OIS eye required postoperative topical IOP-lowering medications. Final BCVA was improved, unchanged, and decreased in 2, 2, and 1 eye, respectively. No intraoperative/postoperative complications or NVI recurrence were observed (mean follow-up: 10.7 months).Conclusion: Intravitreal aflibercept was shown to be a potentially effective additional treatment to PRP and TMC in patients with NVG.

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Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2020/1251203 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hossam M. Moharram ◽

Shaaban Abd-Elhamid Mehany Elwan ◽

Mahmoud M. Nassar ◽

Mohamed F. Abdelkader

Keyword(s):

Case Series ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Case Series Study ◽

Triple Procedure ◽

Distant Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Series Study

Purpose. One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions. Methods. 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study. Results. The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P<0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P<0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period. Conclusions. This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

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A prospective follow-up study of panretinal photocoagulation in preventing neovascular glaucoma following ischaemic central retinal vein occlusion

Survey of Ophthalmology ◽

10.1016/0039-6257(84)90176-0 ◽

1984 ◽

Vol 29 (2) ◽

pp. 160-161

Author(s):

Richard Clemett

Keyword(s):

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Follow Up Study ◽

Vein Occlusion ◽

Central Retinal Vein

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What is the impact of intravitreal injection of conbercept on neovascular glaucoma patients: a prospective, interventional case series study

10.21203/rs.2.105/v2 ◽

2019 ◽

Author(s):

Liukun Shi ◽

Jin Yang ◽

Jinyong Lin

Keyword(s):

Electron Microscopy ◽

Light Microscopy ◽

Intravitreal Injection ◽

Aqueous Humour ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

The Mean ◽

The Impact ◽

Tgf Β1

Abstract Background The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG). Methods Fifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5mg/0.05ml), and then trabeculectomy and panretinal photocoagulation were performed. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-β1 and PLGF in aqueous humour that were collected during surgery were measured by enzyme-linked immunoabsorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed for 2 eyes, and light microscopy was used as the histopathological control. Results The follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 eyes completed the 1-year follow-up and 13 eyes were lost to follow up. Recurrence of iris neovascularization was observed in 5 eyes, 9 eyes had hyphema, 16 eyes had filter bled scarring, no eye had complication attributable to the drug. The mean IOP was reduced from 48.1±14.2 mmHg to 23.2±8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) at 1 year (both P < 0.05). The complete success rate was 76.9%, 76.9%, 71.0%, 51.6%, 32.3% at 1week, 1 month, 3 months, 6 months and 12months when the cut off of IOP was 18mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-β1 in aqueous humour in NVG patients decreased from 168.8±13.4 pg/ml and 159.6±15.4 pg/ml to 160.2±7.6 pg/ml and 151.9±2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cells degeneration in the conbercept-treated specimens. Conclusions Our initial findings suggest that intravitreal conbercept is an effective treatment for managing neovascular glaucoma, with fewer postoperative complications in the short-term. Trial registration Current Controlled Trials ChiCTR1800019918, 8 December 2018, Retrospectively registered.

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Surgical treatment of neovascular glaucoma with Ex-PRESS glaucoma shunt

10.21203/rs.3.rs-247619/v1 ◽

2021 ◽

Author(s):

Cenk Zeki Fikret ◽

Nil Irem Ucgun

Keyword(s):

Neovascular Glaucoma ◽

First Year ◽

Panretinal Photocoagulation ◽

Deep Sclerectomy ◽

Glaucoma Filtration Surgery ◽

The Third ◽

Drainage Device ◽

Group A ◽

Group B

Abstract Purpose To compare the efficacy and safety profile of deep sclerectomy combined with Ex-PRESS shunt versus Ex-PRESS shunt surgery in eyes with neovascular glaucoma. Methods Twenty eyes with neovascular glaucoma secondery to proliferative diabetic retinopathy were included in our study. Panretinal photocoagulation and intravitreal bevacizumab injection were applied to these eyes. Despite full antiglaucomatous treatment and iris, angle neovascularization regression whose intraocular pressures were 21mm Hg and above were taken to surgery. Patients were randomly divided into two groups. Group A (10 patients) underwent deep sclerectomy combined with insertion of Ex-PRESS drainage device, group B (10 patients) underwent only Ex-PRESS glaucoma filtration surgery. Primary outcome measures were the intraocular pressure (IOP) and the number of antiglaucomatous medications at the first year follow-up visit. Results There was no difference in IOP between the groups at the first 2 month postoperatively (p>0.05). In the first 2 months, there was no need for antiglaucomatous medication in either group. In the third month, an antiglaucomatous drug was administered to 2 patients in group A and to 4 patients in group B. IOP values were lower in group A than group B at the third and sixth months (p<0.05). At the end of the first year, ≤18 mm Hg IOP rate was found 80% in group A and 60 in group B without medication. Conclusion Ex-PRESS shunt surgey demonstrated to be an effective treatment in eyes with neovascular glaucoma at the first year follow-up period. Ex-PRESS drainage device implantation with deep sclerectomy increased surgical success.

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Combined vitrectomy, near-confluent endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma

10.1101/2020.01.19.20017889 ◽

2020 ◽

Author(s):

P. Strzalkowski ◽

A. Strzalkowska ◽

W. Göbel ◽

T. Ach ◽

N.A. Loewen ◽

...

Keyword(s):

Central Retinal Artery Occlusion ◽

Case Series ◽

Intravitreal Bevacizumab ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Pain Scale ◽

Artery Occlusion ◽

Panretinal Photocoagulation ◽

One Year

AbstractPurposeEvaluated the safety and efficacy of an integrative surgical approach to neovascular glaucoma (NVG).MethodsConsecutive interventional case series of NVG with one-year follow-up. Eyes underwent pars plana vitrectomy, near-confluent panretinal photocoagulation, intravitreal bevacizumab, and transscleral cyclophotocoagulation. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), glaucoma medication score (GMS), visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6 and 12 months. Blind eyes were excluded.Results83 eyes of 83 patients (53 male, 30 female, mean age 74.6±11.6 years) were included and 53 completed a one-year follow-up. NVG underlying conditions included retinal vein occlusion (n=41), proliferative diabetic retinopathy (n=25), central retinal artery occlusion (n=10), and ocular ischemic syndrome (n=6). Mean IOP decreased postoperatively from 46.0±10.3 mmHg to 14.2±8.9 mmHg (p<0.001), GMS from 4.8 to 1.8 (p<0.001) and VAPS from 6 to 0. BCVA was unchanged. All postoperative complications had resolved at 1 month postop. 26 eyes did not require additional surgical treatment during follow-up.ConclusionsA single, comprehensive surgery session was able to significantly lower IOP, reduce GMS and control pain.

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Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

F1000Research ◽

10.12688/f1000research.26879.2 ◽

2021 ◽

Vol 9 ◽

pp. 1236

Author(s):

Piotr Strzalkowski ◽

Alicja Strzalkowska ◽

Winfried Göbel ◽

Nils A. Loewen ◽

Jost Hillenkamp

Keyword(s):

Central Retinal Artery Occlusion ◽

Case Series ◽

Intravitreal Bevacizumab ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Pain Scale ◽

Artery Occlusion ◽

Panretinal Photocoagulation ◽

Glaucoma Medication

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.

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Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

F1000Research ◽

10.12688/f1000research.26879.1 ◽

2020 ◽

Vol 9 ◽

pp. 1236 ◽

Cited By ~ 1

Author(s):

Piotr Strzalkowski ◽

Alicja Strzalkowska ◽

Winfried Göbel ◽

Nils A. Loewen ◽

Jost Hillenkamp

Keyword(s):

Central Retinal Artery Occlusion ◽

Case Series ◽

Intravitreal Bevacizumab ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Pain Scale ◽

Artery Occlusion ◽

Panretinal Photocoagulation ◽

Glaucoma Medication

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What is the impact of intravitreal injection of conbercept on neovascular glaucoma patients: a prospective, interventional case series study

10.21203/rs.2.105/v3 ◽

2019 ◽

Author(s):

Liukun Shi ◽

Jin Yang ◽

Jinyong Lin

Keyword(s):

Electron Microscopy ◽

Light Microscopy ◽

Intravitreal Injection ◽

Aqueous Humour ◽

Neovascular Glaucoma ◽

Enzyme Linked Immunosorbent Assay ◽

Panretinal Photocoagulation ◽

The Mean ◽

Tgf Β1

Abstract Background The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG). Methods Fifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5 mg/0.05 ml) treatment followed by trabeculectomy and panretinal photocoagulation. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-β1 and PLGF in aqueous humour samples collected during surgery were measured by enzyme-linked immunosorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed in 2 eyes, and light microscopy was used as the histopathological control. Results The follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 completed 1 year of follow-up, and 13 were lost to follow-up. Recurrence of iris neovascularization was observed in 5 eyes, 9 had hyphema, 16 had filter-bled scarring, and no eye had complications attributable to the drug. The mean IOP was reduced from 48.1±14.2 to 23.2±8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) after 1 year (both P < 0.05). The complete success rate was 76.9%, 76.9%, 71.0%, 51.6%, and 32.3% at 1 week, 1 month, 3 months, 6 months and 12 months, respectively, when the cut-off IOP was 18 mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-β1 in the aqueous humour in NVG patients decreased from 168.8±13.4 and 159.6±15.4 pg/ml to 160.2±7.6 and 151.9±2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens treated with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cell degeneration in the conbercept-treated specimens. Conclusions Our initial findings suggest that intravitreal conbercept is an effective treatment for managing NVG that has fewer short-term postoperative complications. Trial registration Current Controlled Trials ChiCTR1800019918, 8 December 2018, retrospectively registered.

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Outcomes of 23-Gauge Vitrectomy Combined with Phacoemulsification, Panretinal Photocoagulation, and Trabeculectomy without Use of Anti-VEGF Agents for Neovascular Glaucoma with Vitreous Hemorrhage

Journal of Ophthalmology ◽

10.1155/2016/3097379 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7

Author(s):

Hua Yan

Keyword(s):

Vitreous Hemorrhage ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Light Perception ◽

Anti Vegf ◽

The Mean ◽

23 Gauge ◽

One Year ◽

Time Point

Purpose. To evaluate the outcomes of 23-gauge vitrectomy combined with phacoemulsification, PRP and trabeculectomy without use of anti-VEGF-agents for NVG. Methods. Eighteen eyes of 18 patients with NVG underwent 23-gauge vitrectomy combined with phacoemulsification, PRP and trabeculectomy without use of anti-VEGF agents. The preoperative BCVA ranged from light perception to 0.2. The preoperative IOP ranged from 38 mmHg to 64 mmHg with a mean of 54±8 mmHg. The average follow-up time was 14.5±3 months with a range from 11 to 24 months. Results. The postoperative VA increased in 14 eyes and was stable in 4 eyes at the final follow-up. The mean IOP was 12±3 mmHg at postoperative day 1. The mean IOP was 15±2 mmHg, 16±3 mmHg, 23±5 mmHg, 28±4 mmHg, 22±5 mmHg, 17±3 mmHg, and 19±4 mmHg at postoperative days 2 and 3, 1, 2, 3, and 12 weeks, and 1 year postoperatively, respectively, with a range from 10 to 30 mmHg at the final follow-up time point of one year. The IOP was significantly lower than the preoperative one 12 weeks postoperatively (p<0.05). Conclusion. 23-gauge vitrectomy combined with phacoemulsification, PRP, and trabeculectomy without use of anti-VEGF-agents is a safe and effective method in treating NVG.

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