Reversing the Rubeotic Rampage – Current Approaches in the Management of Neovascular Glaucoma

2016 ◽  
Vol 10 (01) ◽  
pp. 19
Author(s):  
Ian A Rodrigues ◽  
K Sheng Lim ◽  
◽  
Keyword(s):  
Open Angle Glaucoma ◽  
Neovascular Glaucoma ◽  
Angle Closure ◽  
Panretinal Photocoagulation ◽  
Vascular Endothelial ◽  
Success Rates ◽  
Aggressive Management ◽  
Threatening Condition ◽  
Reduce Risk ◽  
Endothelial Growth Factor

Neovascular glaucoma is a sight-threatening condition, and can rapidly progress from rubeosis with normal intraocular pressure (IOP), to secondary open-angle glaucoma with raised IOP and finally secondary angle-closure glaucoma with uncontrolled IOP. Early detection and aggressive management with panretinal photocoagulation, intravitreal anti-vascular endothelial growth factor (VEGF), topical aqueous suppressants and valved glaucoma drainage surgery can reduce risk of significant visual loss secondary to neovascular glaucoma. This editorial explores some simple measures that can increase surgical success rates and minimise complications.

scholarly journals Diabetic neovascularisation and secondary glaucoma

2011 ◽  
Vol 152 (29) ◽  
pp. 1167-1170 ◽  
Author(s):  
Gábor Holló
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Neovascular Glaucoma ◽  
Late Complications ◽  
Optimal Timing ◽  
Diabetic Patients ◽  
Panretinal Photocoagulation ◽  
Vascular Endothelial ◽  
Laser Treatments ◽  
Endothelial Growth Factor

Neovascular glaucoma develops from intraocular neovascularisation in diabetes mellitus. Neovascularisation is a consequence of hypoxia-induced production of vascular endothelial growth factor-A. Neovascular glaucoma is one of the most serious, sight-threatening late complications of diabetes. Several intraocular pressure lowering drugs, surgical and adjunctive laser treatments have been used to treat this disease, but the efficacy of the interventions is limited. The role of vascular endothelial growth factor-A blocking therapy in the treatment of neovascular glaucoma remains to be determined. Development of neovascularisation, however, can be prevented with adequate long-term glycemic and lipid control, effective treatment of arterial hypertension and optimal timing of adequate panretinal photocoagulation, in the majority of the cases. Unfortunately, in clinical practice diabetic neovascular glaucoma is more frequently experienced in Hungary than would be expected based on the variety of available therapeutic possibilities. In order to increase the success of prevention both cooperation of general practitioners, diabetologists, dietitians and ophthalmologists, and compliance of diabetic patients need to be improved. Orv. Hetil., 2011, 152, 1167–1170.

scholarly journals Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

2019 ◽  
Vol 28 (3) ◽  
pp. 258-67
Author(s):  
Widya Artini ◽  
Ajeng Gracia ◽  
Aria Kekalih ◽  
Virna Dwi Oktariana ◽  
Andi Arus Victor ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Aqueous Humor ◽  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
Vascular Endothelial ◽  
The Mean ◽  
Endothelial Growth Factor

BACKGROUND The aim of this study was to determine the levels of vascular endothelial growth factor (VEGF) in the aqueous humor and the effect of intravitreal anti-VEGF injection combined with panretinal photocoagulation (PRP) on the management in diabetes mellitus (DM) patients with neovascular glaucoma (NVG).  METHODS This study was a prospective, interventional study in DM patients with NVG. Paracentesis followed by intravitreal bevacizumab (IVB) injection was performed in all eyes. The concentration of VEGF obtained from paracentesis was measured. In week-1, the intraocular pressure (IOP), sectorial iris neovascularization (NVI), and visual acuity were documented, and management was continued with PRP laser over a period of 1 week. All parameters and additional interventions performed after PRP were also recorded.  RESULTS A total of 18 eyes from 17 patients were studied. The mean (SD) level of VEGF in the aqueous humor was 3,864 (1,468) pg/ml, and the mean (SD) of initial IOP was 39 (10.2) mmHg. There was a significant reduction in IOP in week-1 after the first intervention to 24.4 (8.0) mmHg (p = 0.001); however, at 2 weeks the IOP increased to 30.4 (6.7) mmHg. NVI showed significant regression in week-1 after IVB combined with PRP laser (p < 0.05). All eyes required additional glaucoma implants (14 eyes) and cyclocryotheraphy (4 eyes).  CONCLUSIONS In the eyes of diabetes patients with NVG, VEGF levels were high. With the use of IVB, the IOP was reduced, and NVI regressed; however, due to the severe stages of disease, all eyes required glaucoma surgery.

scholarly journals Comparison between the Express Implant and Transscleral Diode Laser in Neovascular Glaucoma

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Faried Mohammed Wagdy ◽  
Adel Galal Zaky
Keyword(s):  
Previous History ◽  
Visual Outcome ◽  
Glaucoma Surgery ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
History Of ◽  
Therapeutic Tools ◽  
Endothelial Growth Factor ◽  
Glaucoma Filtration Device ◽  
Filtration Device

Purpose. To compare the outcomes of Ex-PRESS glaucoma filtration device and transscleral cyclophotocoagulation (TSCP) in the management of neovascular glaucoma (NVG). Patients and Methods. A total of 30 eyes (12 express shunts and 18 TSCP) of 28 patients were included. The eyes had NVG with intraocular pressure (IOP) more than 21 mmHg of the maximally tolerated medication treatment after previous panretinal photocoagulation and antivascular endothelial growth factor (anti-VEGF) injection, with no previous history of a cyclodestruction procedure or glaucoma surgery, were randomized either for Ex-PRESS glaucoma filtration device or TSCP. The patients were followed up weekly for the first month and then monthly for 12 months as regard to the IOP, number of topical antiglaucoma drugs required, visual outcome, and postoperative complications. Results. IOP was successfully controlled with both techniques in 83.3% of the eyes. Both techniques had fewer complications and required fewer subsequent procedures. Conclusion. Both the Ex-PRESS glaucoma filtration device and TSCP might constitute safe and alternative therapeutic tools for patients with NVG. However, TSCP is an easier procedure, less time consuming, and does not require a learning curve.

Expression of platelet-derived growth factor-C in aqueous humor of patients with neovascular glaucoma and its correlation with vascular endothelial growth factor

2019 ◽  
Vol 30 (3) ◽  
pp. 500-505
Author(s):  
Yujie Li ◽  
Dan Hu ◽  
Peilin Lv ◽  
Minyan Xing ◽  
Zejuan Song ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Aqueous Humor ◽  
Neovascular Glaucoma ◽  
Platelet Derived Growth Factor ◽  
Vascular Endothelial ◽  
Iris Neovascularization ◽  
Factor C ◽  
Endothelial Growth Factor ◽  
Retinal Photocoagulation

Aim: The aim of this study was to investigate the expression of platelet-derived growth factor-C in aqueous humor of patients with neovascular glaucoma and its correlation with vascular endothelial growth factor. Methods: This study involved 62 eyes of 62 patients with advanced neovascular glaucoma requiring transscleral cyclophotocoagulation. Aqueous humor was collected through paracentesis. Samples from 11 eyes of 11 patients with age-related cataract were collected as control. Concentrations of platelet-derived growth factor-C and vascular endothelial growth factor in aqueous humor were quantified by enzyme-linked immunosorbent assay. Meanwhile, the correlations between the concentrations of platelet-derived growth factor-C and vascular endothelial growth factor were analyzed. The elements including retinal photocoagulation treatment, iris neovascularization grade, and primary fundus disease were also studied to find out their roles in the concentrations of the two factors. Results: The vascular endothelial growth factor and platelet-derived growth factor-C concentrations in aqueous humor from controls were (679.54 ± 49.81) pg/mL and (18.60 ± 1.85) pg/mL, respectively. Both of them were significantly lower than neovascular glaucoma patients ( p < 0.001). The vascular endothelial growth factor and platelet-derived growth factor-C concentrations of neovascular glaucoma patients treated with retinal photocoagulation were (1095.99 ± 52.71) pg/mL and (28.55 ± 0.94) pg/mL, respectively, which were both significantly lower than those of untreated neovascular glaucoma patients, (1146.28 ± 69.57) pg/mL and (30.04 ± 1.64) pg/mL ( p = 0.008, p = 0.034). There was a weak correlation between the expression level of vascular endothelial growth factor and platelet-derived growth factor-C in aqueous humor with neovascular glaucoma ( r = 0.346, p = 0.006). However, iris neovascularization grade and primary fundus disease were not significant elements in the expression level of vascular endothelial growth factor and platelet-derived growth factor-C. Conclusion: Higher concentrations of vascular endothelial growth factor and platelet-derived growth factor-C were found in aqueous humor of patients with neovascular glaucoma compared with control, which could be lowered by retinal photocoagulation to some extent. Platelet-derived growth factor-C inhibitors may be another potential target for ocular neovascular diseases.

Efficacy and safety of single Ultrasound Cyclo-Plasty to treat refractory glaucoma: Results at 1 year

2020 ◽  
pp. 112067212097360
Author(s):  
Zhou Longfang ◽  
Hu Die ◽  
Lan Jie ◽  
Liu Yameng ◽  
Lv Mingyuan ◽  
...  
Keyword(s):  
Success Rate ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Neovascular Glaucoma ◽  
Angle Closure ◽  
Efficacy And Safety ◽  
Refractory Glaucoma ◽  
Ocular Complications ◽  
The Mean ◽  
Main Complication

Purpose: To evaluate clinical efficacy and safety of single Ultrasound Cyclo-Plasty (UCP) in the treatment of advanced refractory glaucoma. Methods: From January 2018 to August 2018, 25 patients (25 eyes) with refractory glaucoma and intraocular pressure (IOP) not controlled by drugs or conventional filtering surgery were included in the study. All subjects (neovascular glaucoma [ n = 12], secondary glaucoma [ n = 6], angle closure glaucoma [ n = 6], and primary open angle glaucoma [ n = 1]) underwent 8-sector Ultrasound Cyclo-Plasty. Patients were followed-up at Day 1, Week 1, and at 1, 3, 6, and 12 months, during which the IOP, the number of IOP lowering drugs and the occurrence of ocular complications were recorded. Clinical outcomes were IOP reduction, success rate, and ocular complications. According to the glaucoma type, patients were divided into a neovascular group (NVG) and a non-NVG group for sub-analysis. Results: All patients underwent a single UCP procedure and mean IOP reduced significantly from 39.7 ± 6.1 mmHg before UCP to 27.1 ± 11.0 mmHg at 1 year ( p < 0.01) corresponding to a mean IOP reduction of 29.6%. The mean number of IOP-lowering drugs used was 2.4 ± 1.2 at baseline and 2.3 ± 1.0 at 12 months. Success rate after a single UCP procedure was achieved in 41.7% patients at 1 year, with a higher success rate in non-NVG than in the NVG group. No major postoperative complications were reported. The main complication was conjunctival congestion, anterior chamber inflammation, scleral ring congestion, and scleral inprint. Of these, scleral ring congestion and scleral imprint are relatively rare complications, which can still be observed 12 months after UCP treatment. Conclusion: UCP for refractory glaucoma is effective in reducing IOP and has a good safety profile. Success rate is lower after a single UCP in NVG than for other types of glaucoma.

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