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

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 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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Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion

Korean Journal of Ophthalmology ◽

10.3341/kjo.2009.23.3.215 ◽

2009 ◽

Vol 23 (3) ◽

pp. 215 ◽

Cited By ~ 5

Author(s):

Min Sagong ◽

Jinseon Kim ◽

Woohyok Chang

Keyword(s):

Central Retinal Artery Occlusion ◽

Intravitreal Bevacizumab ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Retinal Artery

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Intravitreal Bevacizumab for Neovascular Glaucoma following Central Retinal Artery Occlusion

European Journal of Ophthalmology ◽

10.1177/112067210701700220 ◽

2007 ◽

Vol 17 (2) ◽

pp. 269-271 ◽

Cited By ~ 31

Author(s):

Z. Vatavuk ◽

G. Bencic ◽

Z. Mandic

Keyword(s):

Central Retinal Artery Occlusion ◽

Intravitreal Bevacizumab ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Retinal Artery

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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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Central retinal artery and vein occlusion as a complication of persistent hyaloid artery – a case report

BMC Ophthalmology ◽

10.1186/s12886-020-01702-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mirjana Bjeloš ◽

Ana Križanović ◽

Mladen Bušić ◽

Biljana Kuzmanović Elabjer

Keyword(s):

Case Report ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Venous Stasis ◽

Vein Occlusion ◽

Arterial Inflow ◽

Retinal Artery

Abstract Background In this case report, we present for the first time central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) as a complication of persistent hyaloid artery (PHA). Case presentation In August 2019, a six-year-old male patient manifested right eye (RE) excessive tearing, conjunctival injection and pain. On examination, RE demonstrated light perception and intraocular pressure of 36 mmHg. The diagnoses of neovascular glaucoma, CRVO and CRAO were established as affirmed with fluorescein angiography (FA). PHA was not reported. Extensive work-up and family history were unremarkable. The child was born on term after uncomplicated twin pregnancy. In December 2019, he was referred to our Centre. Transillumination revealed fully dilated, non-reactive RE pupil, clear lens and tubular remnant of HA containing blood cells in its lumen freely rotating in the anterior vitreous. Conclusions PHA results from failure of apoptosis during gestation. It can easily be observed during the red reflex screening at neonatal wards. We hypothesized that PHA twisting led to torsion of the residual primordial common bulb, branching off to HA and CRA with CRAO occurring first. The consequential CRVO presumably advanced by venous stasis due to decrease in arterial inflow. Liquid vitreous appears as early as 4 years of age enabling PHA to whirl more freely. Thus, in case of PHA, we advocate FA to be performed and if connection with retinal artery is proven, parents should be informed on the possible devastating complications and prompt surgical treatment should be considered.

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Two-year outcomes of intravitreal ziv-aflibercept

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311591 ◽

2018 ◽

Vol 102 (10) ◽

pp. 1387-1390 ◽

Cited By ~ 17

Author(s):

Ahmad M Mansour ◽

Mohammed Ashraf ◽

Abdulrazzak Charbaji ◽

Muhammad H Younis ◽

Ahmed A Souka ◽

...

Keyword(s):

Macular Oedema ◽

Paired Comparison ◽

Central Retinal Artery Occlusion ◽

Diabetic Macular Oedema ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Rank Test ◽

Macular Diseases ◽

Signed Rank Test

AimTo assess the two-year outcome of intravitreal ziv-aflibercept (IVZ) in eyes with macular diseases.MethodsConsecutive subjects with various macular diseases that received six or more of 0.05 mL IVZ (1.25 mg) injections with at least 1 year follow-up were included. Outcome measures were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution) and central macular thickness (CMT) on spectral domain optical coherence tomography. Paired comparison was done using Wilcoxon signed-rank test calculator.Results107 eyes of 91 subjects received IVZ and were followed with mean±SD follow-up interval of 1.48±0.44 months following treat and extend or pro-re-nata protocol. The distribution included neovascular macular degeneration (42 eyes), diabetic macular oedema (32 eyes) and macular oedema secondary to retinal vein occlusion (11 eyes). Fifty eyes were naive, while 57 eyes were previously treated. Combining all disease categories, CMT decreased significantly by 133.0±153.0 µm at the 24-month follow-up (P<0.001) with BCVA gain of 0.35±0.37 at the 24-month follow-up (P<0.001) with mean number of injections of 8.5 at month 12, 2.4 between 12 and 18 month and 1.7 between 18 and 24 month. Ocular and systemic adverse effects included one episode of transient uveitis and one instance of central retinal artery occlusion after 1121 injections.ConclusionsIVZ appears safe and efficacious in the therapy of macular diseases through 2 years.

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Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014586 ◽

2019 ◽

Vol 11 (7) ◽

pp. 647-652 ◽

Cited By ~ 17

Author(s):

Adam Roche ◽

Emma Griffin ◽

Seamus Looby ◽

Paul Brennan ◽

Alan O’Hare ◽

...

Keyword(s):

Central Retinal Artery Occlusion ◽

Case Series ◽

Intravenous Thrombolysis ◽

Standard Of Care ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Anterior Circulation ◽

Arterial Access ◽

Femoral Approach ◽

Access Complications

BackgroundMechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access.Methods and materialsA review of a prospectively maintained thrombectomy database over a 2-year period (August 2016 – August 2018) was undertaken to identify cases where direct carotid access was performed. CT and angiographic imaging were reviewed. Indications for carotid access, techniques used, technical success of procedure, recanalization rates, procedure-related complications, and patient outcomes were assessed.ResultsEleven patients out of 498 overall thrombectomy procedures (2.2% thrombectomies) underwent direct carotid access. Median National Institutes of Health Stroke Scale was 20. Seventy three percent of patients received intravenous thrombolysis. The direct carotid approach was performed following the failed femoral approach due to unfavorable aortic arch anatomy, vessel tortuosity, and severe atherosclerotic disease. Direct carotid puncture was successful in 10 patients, and unsuccessful in one. Successful recanalization (TICI 2b–3) was achieved in eight patients. One patient had spontaneously recanalized on angiography. There was failed recanalization in one patient with tandem ICA and M1 occlusion. Carotid access complications included one patient with both neck hematoma and asymptomatic ICA dissection, and one of delayed central retinal artery occlusion.ConclusionThis case series highlights direct carotid puncture as a successful alternative when the femoral approach is not possible, allowing thrombectomy in patients who would otherwise be unsuitable.

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