Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy

Abstract

Purpose. To determine the efficacy of intravitreal ranibizumab injection as adjuvant therapy in the treatment of neovascular glaucoma (NVG) accompanied by postvitrectomy diabetic vitreous hemorrhage (PDVH). Methods. Eighteen NVG patients (18 eyes) accompanied by PDVH were enrolled in this prospective, monocenter, 12-month, interventional case series. The consecutive 18 patients with an IOP ≥ 25 mmHg despite being treated with the maximum medical therapy were treated with intravitreal ranibizumab injections. Vitreous surgery or/with Ahmed valve implantation were indicated if no clinical improvement in vitreous haemorrhage and uncontrolled IOP was shown. Results. Ten patients got clear vitreous and controlled IOP only with 2.7 ± 1.8 injections of ranibizumab without additional surgery. Vitrectomy or/with Ahmed valve implantation was administered in the other 8 eyes due to uncontrolled VH and IOP. At follow-up month 12, all the 18 eyes gained clear vitreous. At month 12 BCVA improved significantly compared to baseline. The baseline and follow-up at month 12 IOP/medication usage were 36.7 ± 8.1 mmHg on 3.4 ± 0.7 medications and 16.2 ± 4.9 mmHg on 0.67 ± 0.77 medications, respectively. Conclusions. The findings suggest that intravitreal ranibizumab injection as adjuvant therapy for treatment of NVG accompanied by PDVH may be safe and potentially effective. This clinical trial is registered with NCT02647515.

Figure 1

Intraocular pressure revealed a significant reduction compared to baseline at every follow-up visit during the 12 months (P < 0.01).

Figure 2

Graph showing changes in the number of antiglaucomatous medications applied from baseline to 12 months after treatment. At every follow-up visit, compared to baseline, the number of antiglaucomatous medications undertaken significantly reduced (P < 0.01).

Figure 3

Graph showing changes in mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) from baseline to 12 months after treatment. At earlier visits follow-up (week 2 till month 2), BCVA revealed a modest improvement compared to baseline (P < 0.05). At the remaining visits (month 3 till month 12), the improvement of BCVA reached the significant level compared to baseline (P < 0.01). ∗ represents P < 0.05; ∗∗ represents P < 0.01.