Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Jul-Aug;8(4):308-313.
doi: 10.1097/APO.0000000000000248.

Intravitreal Ranibizumab With Panretinal Photocoagulation Followed by Trabeculectomy Versus Visco-Trabeculotomy in Management of Neovascular Glaucoma

Ahmed S Elwehidy  1 , Nader Hussein Lotfy Bayoumi  2 , Amani E Badawi  1 , Sherein M Hagras  1 , Amr Abdelkader  1
Affiliations
Comparative Study

Intravitreal Ranibizumab With Panretinal Photocoagulation Followed by Trabeculectomy Versus Visco-Trabeculotomy in Management of Neovascular Glaucoma

Ahmed S Elwehidy et al. Asia Pac J Ophthalmol (Phila). 2019 Jul-Aug.

Abstract

Purpose: The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG).

Methods: The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted.

Results: The mean ± SD (range, median) age of the study patients was 54.1 ± 6.4 (40-67, 54.5) and 52.4 ± 8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ± SD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ± 2.97 (39-52, 45.5) and 45.64 ± 3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ± SD (range, median) IOP of the study eyes was 18.19 ± 2.0 (16-23, 17) and 19.92 ± 2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726).

Conclusions: Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
The preoperative and postoperative intraocular pressures for the viscotrabeculotomy group.
FIGURE 2
FIGURE 2
The preoperative and postoperative intraocular pressures for the trabeculectomy with mitomycin C group.
FIGURE 3
FIGURE 3
The preoperative and postoperative intraocular pressures for both groups.
FIGURE 4
FIGURE 4
The Kaplan-Meier survival curves for both procedures.
See this image and copyright information in PMC

References

    1. Weiss DI, Shaffer RN, Nehrenberg TR. Neovascular glaucoma complicating carotid-cavernous fistula. Arch Ophthalmol 1963; 69:304–307. - PubMed
    1. Villacampa P, Menger KE, Abelleira L, et al. Accelerated oxygen-induced retinopathy is a reliable model of ischemia-induced retinal neovascularization. PLoS One 2017; 12:e0179759. - PMC - PubMed
    1. Tailor R, Kinsella MT, Clarke JC. Bevacizumab followed by ahmed valve implantation inthe management of neovascular glauoma. Semin Ophthalmol 2017; 1–7. - PubMed
    1. Kim KL, Suh W. Apatinib, an inhibitor of vascular endothelial growth factor receptor 2, suppresses pathologic ocular neovascularization in mice. Invest Ophthalmol Vis Sci 2017; 58:3592–3599. - PubMed
    1. Sun JT, Liang HJ, An M, et al. Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma. Int J Ophthalmol 2017; 10:400–405. - PMC - PubMed

Publication types

Substances