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. 2016 May 26:16:65.
doi: 10.1186/s12886-016-0248-7.

Intravitreal ranibizumab injection combined trabeculectomy versus Ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications

Lan Liu  1 , Yongfeng Xu  2 , Zhu Huang  1 , Xiaoyu Wang  3
Affiliations

Intravitreal ranibizumab injection combined trabeculectomy versus Ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications

Lan Liu et al. BMC Ophthalmol. .

Abstract

Background: Researches have shown anti-vascular endothelial growth factor (VEGF) agent is effective in treating neovascular eye diseases. The purpose of this study is to evaluate the efficacy and safety of intravitreal ranibizumab (IVR) injection combined trabeculectomy in the treatment of neovascular glaucoma (NVG), and compared it with Ahmed valve surgery.

Methods: Thirty-six NVG patients (37 eyes) from the First Affiliated Hospital of Zhejiang medical college, between January 1, 2014 and January 31, 2015, were included in this prospective, interventional clinical study. Eighteen NVG eyes were given IVR injection one week before trabeculectomy. Ahmed valve implantation surgery was performed in nineteen eyes. Ocular pain, best corrected visual acuity (BCVA), intraocular pressure (IOP) and surgical complications were evaluated before and after the surgery.

Results: IOP was significantly decreased following IVR injection combined trabeculectomy treatment (baseline 57.1 ± 8.9 mmHg; week 1, 15.2 ± 4.3 mmHg p = 0.000; month 1, 16.9 ± 2.1 mmHg p = 0.000; month 3, 20.3 ± 7.7 mmHg p = 0.000; month 6, 19.7 ± 7.3 mmHg p = 0.000). There was a significant, though modest, BCVA improvement in sighted eyes of IVR group (baseline 2.42 ± 0.68, W1 1.80 ± 0.91, P = 0.013; M1 1.77 ± 0.93, p = 0.011). IVR injection combined trabeculectomy had less postoperative complications and lower failure ratio than Ahmed surgery (IVR 5.6 %, Ahmed 31.6 %).

Conclusions: The study revealed that IVR injection combined trabeculectomy was an effective and safe treatment for NVG. Compared with Ahmed surgery, IVR injection combined trabeculectomy had less complications and higher success ratio. (Chinese Clinical Registry, TRN ChiCTR-OPN-16008147, 3/24/2016, retrospectively registered).

Keywords: Ahmed valve surgery; Neovascular glaucoma (NVG); Ranibizumab; Trabeculectomy; Vascular endothelial growth factor (VEGF).

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Figures

Fig. 1
Fig. 1
Anterior segment photography of a neovascular glaucoma patient before and after intravitreal ranibizumab injection (IVR). a. Massive new vessels (black arrows) were seen on the iris around the pupil before IVR. b. New vessels were regressed (black arrows) three days after IVR from the same patient of A
Fig. 2
Fig. 2
Mean intraocular pressure (IOP) before and after the surgery in intravitreal ranibizumab injection (IVR) group and Ahmed surgery (Ahmed) group. *, P < 0.05 compared with the baseline of IVR group, #, P < 0.05 compared with the baseline of Ahmed group. NS, P > 0.05 compared with the baseline of IVR group
See this image and copyright information in PMC

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