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Randomized Controlled Trial
. 2021 Apr;41(4):1179-1190.
doi: 10.1007/s10792-020-01673-1. Epub 2021 Jan 2.

Various modalities for management of secondary angle closure neovascular glaucoma in diabetic eyes: 1-year comparative study

Heba Magdy Ahmed El-Saied  1 , Mohamad Amr Salah Eddin Abdelhakim  2
Affiliations
Randomized Controlled Trial

Various modalities for management of secondary angle closure neovascular glaucoma in diabetic eyes: 1-year comparative study

Heba Magdy Ahmed El-Saied et al. Int Ophthalmol. 2021 Apr.

Abstract

Purpose: To compare outcome of 4 methods for management of angle closure neovascular glaucoma (NVG) in diabetic eyes.

Methods: Prospective comparative study, on 40 eyes (40 patients) with NVG. Patients were randomly assigned to group A (Trabeculectomy with MMC), B (Ahmed valve), C (Ex-Press Minishunt with MMC) or D (Diode cyclophotocoagulation). Patients were followed regularly for 1 year.

Main outcome measures: intraocular pressure (IOP), best corrected visual acuity (BCVA), central foveal thickness (CFT), intraoperative bleeding, postoperative complications and 2ry intervention.

Results: Preoperative data were not significantly different between 4 groups. Postoperatively, there was significant drop in IOP in each group at each follow-up. Ahmed valve group showed least mean postoperative IOP and highest mean drop of the IOP at 1 day and 1 week postoperatively, while Ex-Press minishunt group had least mean postoperative IOP at 1 month and 3 months postoperatively. At 6 months and 1 year, there was no significant difference between 4 groups. BCVA was not significantly different between 4 groups. At 1 year, CFT was significantly lower in each of the 4 groups, and it was significantly the least in group A and highest in group D. Highest intraoperative bleeding was observed with trabeculectomy. Success rate was not significantly different among the 4 groups.

Conclusion: The 4 management options showed a significant long-term effect on IOP, and on long-terms there was no significant difference between them for IOP and BCVA. Trabeculectomy showed highest incidence of intraoperative bleeding, while cyclophotocoagulation showed none.

Keywords: Ahmed valve; Angle closure neovascular glaucoma; Ex-press minishunt; Trabeculectomy; Trans-scleral diode laser cyclophotocoagulation.

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