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

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.

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

Medical Council ◽

10.21518/2079-701x-2021-12-374-378 ◽

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.

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

Journal of Ophthalmology ◽

10.1155/2014/317694 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

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.

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The results of glaucoma drainage tube surgery in patients with diabetes

Diabetes Mellitus ◽

10.14341/dm2003414-16 ◽

2016 ◽

Vol 19 (3) ◽

pp. 237-241

Author(s):

Mukharram M. Bikbov ◽

Ilnur I. Khusnitdinov

Keyword(s):

Visual Function ◽

Neovascular Glaucoma ◽

Hypotensive Effect ◽

Early Postoperative Period ◽

Group I ◽

Ahmed Valve ◽

Patients With Diabetes ◽

The Mean ◽

Group Ii

Aim. To compare the effectiveness of "Glautex" drainage and the Ahmed valve for the treatment of secondary neovascular glaucoma in patients with diabetes.Material and methods. We observed 28 eyes with neovascular glaucoma in 28 patients with proliferative diabetic retinopathy. The mean age of patients was 56.61 ± 1.43 years (range: 40–65). There were 11 males and 17 females. Patients were divided into two groups based on the drainage device used. The first group included 13 patients (13 eyes) for whom "Glautex" drainage was used, while the second group included 15 patients for whom the Ahmed valve model FP7 (New World Medical Inc., USA) was used.Results. The absolute hypotensive effect [normalization of intraocular pressure (IOP) without the use of drugs] 1 year after surgery was 46.1% (6/13) in group I and 60% (9/15) in group II. The relative hypotensive effect (normalization of IOP during treatment with glaucoma drugs) 1 year after surgery was 53.8% (7/13) in group I and 80% (12/15) in group II. Hyphema in the early postoperative period was observed in 30.7% (4/13) and 26.6% (4/15) of patients in groups I and II, respectively. Hypotension with choroid detachment was observed in 23.1% (3/13) of group I patients and 13.3% (2/15) of group II patients. Migration of the tube to the scleral layers occurred after implantation of the Ahmed valve in 6.6% (1/15) of patients.Conclusion. Comparative analysis of the outcomes of surgical treatment of secondary neovascular glaucoma in patients with diabetes showed that the most effective method to lower IOP was implantation of an Ahmed valve. The valve preserved visual function during the 1-year follow-up period and resulted in failed outcomes in only 20% of patients. The hypotensive effect of sinus trabeculectomy was observed in 53.8% of patients with "Glautex" drainage. There was a progressive decrease in visual function and the need for reintervention in 46.1% of group 1 patients.

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EFFECTIVENESS OF EX-PRESS AND AHMED DRAINAGE DEVICES IN PATIENTS WITH SECONDARY NEOVASCULAR GLAUCOMA

Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук ◽

10.12737/23719 ◽

2016 ◽

Vol 1 (6) ◽

pp. 28-31

Author(s):

Бикбов ◽

Mukharram Bikbov ◽

Хуснитдинов ◽

Ilnur Khusnitdinov

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Neovascular Glaucoma ◽

Hypotensive Effect ◽

Drainage Device ◽

Maximum Value ◽

Ahmed Valve ◽

Patients With Diabetes

The purpose of the study was to compare the efficacy of Ex-Press and Ahmed drainage devices for the secondary neo-vascular glaucoma (NVG) in patients with diabetes mellitus. We observed 25patients (25eyes) with secondary NVG in the setting of proliferative diabetic retinopathy. The first group consisted of 10patients (10eyes) who underwent Ex-Press drainage implantation. The second group consisted of 15patients (15eyes) who were implanted Ahmed valve FP7 model. As a result the maximum value of IOP in the analyzed groups decreased by 66.8% and 64.2% respectively immediately after the surgery. By the end of 18months follow-up period, the absolute hypotensive effect in patients of group1 was 20% (2/10) whereas in group2 – 60% (9/15). Normal intraocular tension during treatment with glaucoma medications established in 30% of cases in group1 (3/10) and in 80% of patients in group2 (12/15). Thus, the use of Ex-Press drainage device for secondary NVG in patients with diabetes was ineffective in 70% of cases. We can recommend choosing implantation of Ahmed valve for secondary NVG in patients with diabetes mellitus as the number of unsuccessful outcomes using Ahmed valve was observed only in 20% of cases.

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Time of vitreal surgery for active retinopathy of prematurity

Acta biomedica scientifica ◽

10.29413/abs.2021-6.6-1.11 ◽

2021 ◽

Vol 6 (6-1) ◽

pp. 96-104

Author(s):

A. V. Tereshchenko ◽

I. G. Trifanenkova ◽

N. N. Yudina ◽

M. S. Tereshchenkova ◽

E. V. Erokhina ◽

...

Keyword(s):

Surgical Treatment ◽

Laser Treatment ◽

Retinopathy Of Prematurity ◽

Surgical Intervention ◽

Laser Coagulation ◽

Optimal Timing ◽

Group 3 ◽

Group 2 ◽

Group 1

Background. The anatomical and functional results of surgery for retinopathy of prematurity (ROP) are determined not only by the stage of the pathological process, but also depend on the timing of its implementation.The aim: to estimate the effectiveness of vitrectomy for severe active retinopathy of prematurity, depending on the timing of surgical treatment.Methods. Vitreoretinal surgery was performed in 138 children (198 eyes) with severe stages of ROP. All patients were divided into three groups depending on the timing of surgical treatment: group 1 – 42–48 weeks of postconceptual age (PCA), with the progression of ROP after laser coagulation of the retina (LCS), group 2 – 39–41 weeks of PCA, with the progression of ROP after LCS, group 3 – 36–39 weeks of PCA, without previous LCS. A 3-port transscleral 27-G vitrectomy was performed by all patients. At the postoperative period, the results of vitrectomy were estimated by the anatomical attachment of the retina. The follow-up period was 12 months. Results. In group 1, in 31 cases (73.8 %), the surgical intervention was completed with silicone tamponade. By the end of the follow-up period, anatomical retinal attachment was achieved in 17 eyes (40.5 %).In group 2, surgical intervention was completed with silicone tamponade in 29 eyes (42 %). By the end of the follow-up period, anatomical retinal attachment was achieved in 52 eyes (75 %).In group 3, surgical intervention was completed with silicone tamponade in 11 of 87 eyes (12.6 %). Anatomical retinal attachment was achieved in 80 eyes (92 %).Conclusion. Untimely vitrectomy (42–48 weeks of PCA) in cases of ROP progression after LCR led to a worse result. If progress of ROP after laser treatment happens, early vitrectomy (39–41 weeks of PCA) should be performed. Primary vitrectomy should be performed in case of the optimal timing of laser treatment has been missed (after 36 weeks of PCV).

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Angiographic Findings in Cases with a History of Severe Retinopathy of Prematurity Treated with anti-VEGFs Follow-up to Age 6 Years

10.21203/rs.3.rs-335877/v1 ◽

2021 ◽

Author(s):

Hande Celiker ◽

Ozlem Sahin

Keyword(s):

Laser Treatment ◽

Retinopathy Of Prematurity ◽

Posterior Pole ◽

Vascular Endothelial ◽

Anti Vegf ◽

History Of ◽

Endothelial Growth Factor ◽

Developmental Features

Abstract Purpose: To report the effects of anti-vascular endothelial growth factor (VEGF) treatment in vascular development for cases of acute retinopathy of prematurity (ROP) using fluorescent angiography (FA) and to present the results of our observational approach to retinal sequelae.Methods: A total of 31 eyes in 19 patients with a history of treatment with anti-VEGF agents for classic type 1 ROP and aggressive posterior ROP who underwent FA between March 2014 to February 2020 were reviewed. Angiograms of retinal developmental features of patients aged 4 months to 6 years were examined. Results: The patients mean gestational age were 26.06±1.90 weeks and the mean birth weight were 837.68±236.79g. All cases showed various abnormalities at the vascular and avascular retina, and the posterior pole. All but one case showed a peripheral avascular area on FA evaluation during the follow-up period. We did not apply prophylactic laser treatment to these avascular retina. On the final examination, except one case, we did not observe any late reactivation in any patients. Conclusion: FA is an important tool for assessing vascular maturation in infants. Every leakage should not be assumed to be evidence of late activation, as some leaks may be related to vascular immaturity. Retinal vascularization may not be completed in all patients, however this does not mean that all these patients need prophylactic laser application. Our observational approach may be more daring than the reports frequently encountered in the literature, but it should be noted that unnecessary laser treatment will also eliminate all the advantages of anti-VEGF treatment.

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

Clinical Practice ◽

10.17816/clinpract89576 ◽

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.

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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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Micropulse Transscleral Cyclophotocoagulation in the Combine Treatment of Neovascular Glaucoma

GlaucomaNews ◽

10.25276/2227-8281-1-71-75 ◽

2020 ◽

pp. 71-75

Author(s):

N.S. Khodzhaev ◽

◽

A.V. Sidorova ◽

M.A. Eliseeva ◽

◽

...

Keyword(s):

Laser System ◽

Combined Treatment ◽

Neovascular Glaucoma ◽

Ultrasound Biomicroscopy ◽

Vascular Growth ◽

Vegf Inhibitor ◽

Anti Vegf ◽

Surgical Methods ◽

Treatment Procedures

Introduction. Neovascular glaucoma (NVG) is one of the most prognostically unfavorable forms of the glaucomatous process. The leading pathogenetic mechanism for the development of NVH is hypoxia of the inner layers of the retina, leading to the development of endothelial vascular growth factors (VEGF), which induce neovascular proliferation. In the presence of newly formed vessels in the corner of the anterior chamber, the use of traditional surgical methods for treating glaucoma is limited. That is why the search for a new pathogenetically oriented methods for the treatment of NVH is still acute issue in ophthalmology. Purpose. To evaluate the preliminary results of combined treatment, including intraocular introduction of anti-VEGF therapies (ranibizumab) and micropulse cyclophotocoagulation, in patients with secondary neovascular glaucoma. Materials and methods. The study included 15 patients (15 eyes) with secondary neovascular glaucoma. The value of intraocular pressure (IOP) before surgery ranged from 28 to 44 mm Hg. (average 36.3 ± 4.4 mm Hg), the number of hypotensive drops was 3.5 ± 0.5. The combine treat of patients including the intraocular administration of a VEGF inhibitor (ranibizumab) and through 7-14 days transscleral diode-laser cyclophotocoagulation in micropulse mode on the device «Cyclo G6 Glaucoma Laser System» (IRIDEX, USA) with a laser power of 2000 mW, an exposition of 160 s (80 s in each hemisphere) and a duty cycle of 31.3%. Results. All treatment procedures were performed without complications. By 6 months of follow-up, the average IOP level was 26.9 ± 3.3 mm Hg, the number of hypotensive drops was reduced to 2.7 ± 0.7 drugs. By 1 month of observation, a decrease in the number of newly formed vessels of the iris was achived in all patients. According to ultrasound biomicroscopy, the thickness of the ciliary body (CT) before treatment was on average 0.58 ± 0.14 mm. By 6 months of follow-up, no cases of postoperative atrophy of CT was diagnosed, the thickness of the CT was on average 0.53 ± 0.11 mm. According to the data of optical coherence tomography in the angiography mode, in all cases there was a positive dynamic in 1 month after combined treatment - a significant decrease in macular edema, the area of the retinal nonperfusion zone and the number of newly formed vessels. Conclusion. Combined treatment of patients with secondary neovascular glaucoma, including intraocular introduction of anti-VEGF therapies and micropulse cyclophotocoagulation, is an effective and safe method for reducing IOP.

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Treatment outcomes of central retinopathy of prematurity with localization in the Moscow regional perinatal center

Russian Pediatric Ophthalmology ◽

10.17816/rpoj70957 ◽

2021 ◽

Vol 16 (3) ◽

pp. 19-26

Author(s):

A. Y. Panova ◽

A. S. Petrova ◽

S. A. Trusova ◽

O. A. Shevernaya

Keyword(s):

Laser Treatment ◽

Retinopathy Of Prematurity ◽

Promising Result ◽

Antiangiogenic Therapy ◽

Combined Treatment ◽

Posterior Pole ◽

Laser Coagulation ◽

Vegf Inhibitor ◽

Anti Vegf ◽

Perinatal Center

BACKGROUND: Ranibizumab is widely used in retinopathy of prematurity. Therefore, it is necessary to evaluate the effectiveness, the risk of complications, and recurrence of the disease by antiangiogenic therapy. AIM: To demonstrate the experience of using anti-VEGF drugs in the Moscow Regional Perinatal Center and the effectiveness of different approaches to retinopathy of prematurity (ROP) treatment in the central retinal zone. MATERIAL AND METHODS: The case histories of 17 deeply premature infants with threshold ROP stages and localization in the posterior pole were retrospectively analyzed. Children were treated with intravitreal VEGF inhibitor (total 9 children), 5 children underwent laser coagulation of the retina, and 3 children received combined treatment (laser and intravitreal administration of a VEGF inhibitor). RESULTS: The average age of development of threshold stages was 35.2 weeks (range: 30.539 weeks) in our study. The frequency of promising outcomes after using anti-VEGF drugs alone or in conjunction with peripheral laser treatment was 100%. In comparison, the only laser treatment generated a promising result in 70% of the eyes. However, ROP relapses after anti-VEGF therapy developed at 37, 43, 44,5 weeks. In addition, 1 out of 9 children developed a recurrence of ROP and required laser treatment 7 weeks after using anti-VEGF. CONCLUSION: The use of anti-VEGF therapy is an effective method for the treatment of ROP of the posterior pole. However, there is the ambiguity of the available recommendations on the further management of children. Therefore, it is necessary to monitor the children who have received antiangiogenic therapy for as long as possible.

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