scholarly journals Management of patients with operated refractory neovascular glaucoma (clinical observation)

2021 ◽  
pp. 374-378
Author(s):  
A. A. Gamidov ◽  
Z. V. Surnina ◽  
I. V. Andreeva
Keyword(s):  
Optic Nerve ◽  
Antihypertensive Drugs ◽  
Optimal Algorithm ◽  
Venous Blood ◽  
Neovascular Glaucoma ◽  
Laser Coagulation ◽  
Venous Blood Flow ◽  
Anti Vegf ◽  
Vascular Growth Factor ◽  
Central Retinal Vein

Introduction. Thrombosis (occlusion) of the central retinal vein (RCVO) and its branches is one of the main causes of loss or significant decrease in vision, including in people of working age, while RCVO is the second most common retinal vascular disease after diabetic retinopathy. The incidence rates steadily increase with age, amounting to 0.7% in the 49–60 age group and reaching 4.6% in people over 80 years old. Acute violation of retinal venous blood flow often leads to retinal ischemia, triggering the mechanism of activation of endothelial vascular growth factor (VEGF). In a quarter of patients, occlusions of the retinal veins and its branches initially proceed according to the ischemic type, which is characterized by the formation of extensive non-perfused retinal zones occupying an area of 10 or more areas of the optic nerve head (optic nerve disc) according to fluorescent angiography (FAG). In 34% of such patients, the non-ischemic type of venous occlusion becomes ischemic within 3 years.Aim. To develop an optimal algorithm for  the  management of  patients with operated neovascular uncompensated glaucoma against the background of occlusion of the central retinal vein.Materials and methods. Two patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Aflibercept (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed.Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up.Conclusion. The use of combined laser technologies and anti-VEGF therapy allows potentiating and prolonging the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma against the background of occlusion of the central retinal vein. 

Сombined (anti-VEGF and laser) treatment for operated secondary refractory neovascular glaucoma

2021 ◽  
pp. 24-26
Author(s):  
A.A. Gamidov ◽  
◽  
Z.V. Surnina ◽  
I.V. Andreeva ◽  
I.A. Velieva ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Antihypertensive Drugs ◽  
Optimal Algorithm ◽  
Sequential Therapy ◽  
Neovascular Glaucoma ◽  
Hypotensive Effect ◽  
Laser Coagulation ◽  
Anti Vegf ◽  
Secondary Refractory

Purpose. To develop an optimal algorithm for the management of patients with operated neovascular uncompensated glaucoma. Material and methods. 2 patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Ranibizumab (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed. Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up. Conclusion. The use of combined laser technologies and anti-VEGF therapy makes it possible to potentiate and prolong the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma. Key words: operated neovascular glaucoma, anti-VEGF, combined laser treatment.

scholarly journals The Effect of Antivascular Endothelial Growth Factor Therapy on the Development of Neovascular Glaucoma after Central Retinal Vein Occlusion: A Retrospective Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Christina L. Ryu ◽  
Adrian Elfersy ◽  
Uday Desai ◽  
Thomas Hessburg ◽  
Paul Edwards ◽  
...  
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Significant Risk ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Central Retinal Vein

Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes.Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG.Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average.Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes.

scholarly journals Long Term Outcome and Histologic Findings of a Retinal Astrocytic Hamartoma Treated with Intravitreal Injection of Anti-VEGF: A Case Report

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Kinza T. Ahmad ◽  
Hana A. Mansour ◽  
Benjamin T. Rollins ◽  
Sergio Pina Oviedo ◽  
Paul H. Phillips ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Vitreous Hemorrhage ◽  
Neovascular Glaucoma ◽  
Subependymal Giant Cell Astrocytoma ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Anti Vegf ◽  
Histopathologic Evaluation ◽  
Progressive Growth ◽  
Astrocytic Hamartoma

Background. To our knowledge, this is the first report to describe the histologic changes of a retinal astrocytic hamartoma (RAH) in a patient with tuberous sclerosis complex (TSC) treated with antivascular endothelial growth factor (anti-VEGF), as well as the longest anti-VEGF treatment that such a patient has received (3 years). Case Presentation. We present a case of a 20-year-old female with TSC who developed progressive growth of a papillary astrocytic hamartoma that caused significant retinal edema, vitreous hemorrhage, and neovascular glaucoma. The patient was initially treated with 25 intravitreal anti-VEGF injections about every 1-3 months, but eventually developed a blind painful eye from neovascular glaucoma. Histopathologic evaluation of the enucleated globe showed a peculiar difference of the tumor according to its topography, with features reminiscent of pilocytic astrocytoma at the optic nerve head and features reminiscent of subependymal giant cell astrocytoma at the retrolaminar optic nerve. We hypothesize that these changes occurred as a secondary effect of the anti-VEGF treatment. Conclusions. Anti-VEGF agents may decrease the ophthalmologic complications of RAH. We recommend that this treatment should be started early and continued for a protracted time at regular and frequent intervals. Moreover, a combination of therapies might prove to be superior to monotherapy and should therefore be considered in aggressive retinal astrocytic hamartomas.

scholarly journals Combined treatment of post-thrombotic neovascular glaucoma (clinical case study)

2021 ◽  
Vol 20 (3) ◽  
pp. 41-48
Author(s):  
A. V. Starostina ◽  
A. V. Sidorova ◽  
O. B. Klepinina ◽  
K. S. Norman ◽  
E. A. Smirnova ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Angiogenesis Inhibitor ◽  
Neovascular Glaucoma ◽  
Laser Coagulation ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Clinical Case Study ◽  
Ahmed Valve ◽  
Anterior Eye Segment ◽  
Central Retinal Vein

PURPOSE. To present the features of the clinical course and evaluate the effectiveness of laser and surgical treatment of patients with neovascular glaucoma following central retinal vein thrombosis.MATERIALS AND METHODS. Two patients with neovascular glaucoma secondary to central retinal vein thrombosis were examined. Surgical interventions were performed: patient M. — micropulse cyclophotocoagulation (twice), intravitreal administration of an angiogenesis inhibitor (5 injections), retinal laser coagulation (two-stage); patient E. — micropulse cyclophotocoagulation, intravitreal administration of an angiogenesis inhibitor (2 injections), implantation of the Ahmed valve.RESULTS. The treatment resulted in compensation of intraocular pressure (IOP), improvement of visual functions, reduction of neovascularization in the structures of the anterior eye segment.CONCLUSION. Micropulse cyclophotocoagulation can be used in the complex treatment of neovascular glaucoma at any stage in order to reduce IOP and decrease the neovascularization in the iris and anterior chamber angle structures in the postoperative period.

scholarly journals TRANSPUPILLARY THERMOTHERAPY OF THE OPTIC NERVE DISK IN THE TREATMENT OF CENTRAL RETINAL VEIN OCCLUSION

2016 ◽  
Vol 1 (6) ◽  
pp. 9-14
Author(s):  
Юрьева ◽  
Tatyana Yureva ◽  
Щуко ◽  
Andrey Shchuko ◽  
Акуленко ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Nerve Fibers ◽  
Laser Coagulation ◽  
Ophthalmological Examination ◽  
Transpupillary Thermotherapy ◽  
Vein Occlusion ◽  
Regional Hemodynamics ◽  
Central Retinal Vein

Purpose: to make a pathogenetic basis and assessment of the clinical efficacy of transpupillary thermotherapy (TTT) of the optic nerve disc in central retinal vein occlusion (CRVO). Materials and methods: ophthalmological examination with in-depth study of regional hemodynamics, layered structure of the retina, its electrical sensitivity and neural conductivity in 15 patients with CRVO before and after TTT of the optic nerve disc. Results. After TTT of the optic nerve in patients with CRVO, immediately after treatment visual acuity increased twofold, the thickness of the retina significantly decreased in central and peripapillary regions and indices of high-speed blood flow of central retinal vein improved. In 3-6 months, retinal thickness, ERG indices and visual evoked potentials recovered practically to the level of the fellow eye. It was established that after the TTT of the optic nerve the perfusion in the blood vessels of the retina and optic nerve has improved, which was accompanied by a decrease in the height and the area of ischemic edema in the peripapillary area, improved conduction of impulses along nerve fibers. In contrast to conservative therapy and laser coagulation, after a single session of TTT of the optic nerve, visual function improvement occurred in 89 % of cases. Conclusions. TTT of the optic disc is a highly effective, pathogenetically proved and safe method of treatment purposefully influencing the regional hemodynamics, making possible to achieve positive structural and functional changes of the visual system in CRVO.

scholarly journals Impact of laser coagulation in severe twin-twin transfusion syndrome on fetal Doppler indices and venous blood flow volume

2002 ◽  
Vol 20 (2) ◽  
pp. 125-130 ◽  
Author(s):  
E. Gratacós ◽  
D. Van Schoubroeck ◽  
E. Carreras ◽  
R. Devlieger ◽  
E. Roma ◽  
...  
Keyword(s):  
Blood Flow ◽  
Venous Blood ◽  
Laser Coagulation ◽  
Venous Blood Flow ◽  
Flow Volume ◽  
Fetal Doppler ◽  
Blood Flow Volume ◽  
Doppler Indices

scholarly journals The study of the efficiency of micropulse transscleral cyclophotocoagulation in the combined treatment of patients with secondary neovascular glaucoma

2021 ◽  
Vol 12 (4) ◽  
pp. 44-50
Author(s):  
Alla V. Sidorova ◽  
Anna V. Starostina ◽  
Mariia A. Pecherskaia ◽  
Margarita R. Khabazova ◽  
Alexey A. Arisov
Keyword(s):  
Combined Treatment ◽  
Pain Syndrome ◽  
Neovascular Glaucoma ◽  
Laser Coagulation ◽  
Post Surgery ◽  
Anti Vegf ◽  
Fast Development ◽  
Hypotensive Therapy ◽  
Transscleral Cyclophotocoagulation ◽  
High Level

Background: Neovascular glaucoma (NVG) is a highly refractory form, it is characterized by fast development and a high level of the intraocular pressure (IOP). Aims: To evaluate the effectiveness of micropulse transscleral cyclophotocoagulation (mCPC) in the combined treatment of patients with secondary neovascular glaucoma. Methods: The study included 32 patients (32 eyes) with secondary NVG as an outcome of diabetes mellitus and (or) thrombosis of the central retinal vein or its branches. The preoperative IOP averaged 38.88.8 mm Hg with the most intense hypotensive therapy. All the patients underwent mCPC. In the postoperative period, the patients were examined on the first day after the operation, then in 1 week, 1, 3, 6 months, 1 year after the operation. Results: All the operations were performed without complications. Pain syndrome in all cases was stopped on the first day after surgery. Six patients had reactive hypertension on the first day, therefore, the hypotensive therapy was intensified. The IOP 1 week after mCPC was 20.97.9 mm Hg, after 1 month of observation 23.76.0 mm Hg with the hypotensive therapy. 34 weeks post-surgery, six patients with the preserved visual function experienced a repeated IOP increase, and the Ahmed valve was implanted. 6 months after mCPC, the IOP level averaged 22.87.7 mm Hg with the hypotensive therapy. Against the background of the IOP compensation, anti-VEGF drugs were injected in 4 cases, followed by laser coagulation of the retina. Conclusion: Application of mCPC in NVG glaucoma patients showed only a small number of postoperative complications. This method of laser treatment can be used in combination with panretinal laser coagulation before or after the surgery, including administration of anti-VEGF drugs before or after the surgery. In case of the IOP increase, mCPC may be repeated.

scholarly journals Cytokines and Pathogenesis of Central Retinal Vein Occlusion

2020 ◽  
Vol 9 (11) ◽  
pp. 3457
Author(s):  
Hidetaka Noma ◽  
Kanako Yasuda ◽  
Masahiko Shimura
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Vision Loss ◽  
Neovascular Glaucoma ◽  
Retinal Blood Flow ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Central Retinal Vein

Central retinal vein occlusion (CRVO) causes macular edema and subsequent vision loss and is common in people with diseases such as arteriosclerosis and hypertension. Various treatments for CRVO-associated macular edema have been trialed, including laser photocoagulation, with unsatisfactory results. However, when the important pathogenic role of vascular endothelial growth factor (VEGF) in macular edema was identified, the treatment of CRVO was revolutionized by anti-VEGF therapy. However, despite the success of intraocular injection of anti-VEGF agents in many patients with CRVO, some patients continue to suffer from refractory or recurring edema. In addition, the expression of inflammatory cytokines increases over time, causing more severe inflammation and a condition that is increasingly resistant to anti-VEGF therapy. This indicates that the pathogenesis of macular edema in CRVO is more complex than originally thought and may involve factors or cytokines associated with inflammation and ischemia other than VEGF. CRVO is also associated with leukocyte abnormalities and a gradual reduction in retinal blood flow velocity, which increase the likelihood of it developing from the nonischemic type into the more severe ischemic type; in turn, this results in excessive VEGF expression and subsequent neovascular glaucoma. Here, we review the role of different factors and cytokines involved in CRVO pathogenesis and propose a mechanism that holds promise for the development of novel therapies.

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