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Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis

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  • Published:
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Abstract

Purpose

This literature review and meta-analysis aims to compare intraocular pressure (IOP) lowering efficacy, failure rates and loss of light perception (LP) rates 6 months after an IOP-lowering surgical procedure in neovascular glaucoma (NVG) eyes.

Methods

MEDLINE and EMBASE were used as data sources. Only studies including NVG patients who underwent two different surgical approaches were considered. The treatment effect measures were (i) weighted mean difference (WMD) for IOP reduction, (ii) risk ratio (RR) for failure rates and (iii) risk difference (RD) for loss of LP. Outcome measures were reported with a 95% confidence interval (CI) and P < 0.05 was considered statistically significant. Analysis was performed using RevMan v5.0.

Results

No RCT were retrieved. Seven comparative non-randomised studies were eligible. In glaucoma drainage devices (GDDs) vs cyclophotocoagulation arm, there was no statistical difference in IOP-lowering efficacy (WMD = − 3.63; CI [− 8.69, 1.43], P = 0.16), although failure rates and loss of LP were lower in the GDDs group (RR = 0.64, CI [0.41, 0.99], P = 0.05; and RD = − 0.15, CI [− 0.25, − 0.05], P = 0.004, respectively). In the Ahmed glaucoma valve (AGV) vs trabeculectomy arm, there was no statistical difference in IOP-lowering efficacy and loss of LP (WMD = 0.78, CI [− 2.29, 3.85], P = 0.62 and RD of 0.04, CI [− 0.05, 0.14], P = 0.34, respectively), but failure rates were lower in trabeculectomy group (RR of 2.25, CI [1.14, 3.71], P = 0.02).

Conclusions

There is lack of high-quality evidence on the subject as no RCT were retrieved comparing two different IOP-lowering procedures in NVG patients. Our findings are based, therefore, on non-RCT studies and should be interpreted with caution. There appears to be no difference in IOP-lowering efficacy between GDDs and cyclophotocoagulation, although GDDs appear to be safer. AGV and trabeculectomy also seem to provide similar IOP-lowering results with trabeculectomy showing lower failure rates.

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Abbreviations

IOP:

intraocular pressure

LP:

light perception

NVG:

neovascular glaucoma

WMD:

weighted mean difference

RR:

risk ratio

RD:

risk difference

CI:

confidence interval

GDDs:

glaucoma drainage devices

AGV:

Ahmed glaucoma valve

VEGF:

vascular endothelial growth factor

AH:

aqueous humour

RCTs:

randomised clinical trials

MMC:

mitomycin C

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Acknowledgments

We thank Joana Alarcão MD for her contribution in elaborating the search strategy for this review. We also thank Filipe Rodrigues MD for assistance in the electronic search.

Author information

Authors and Affiliations

  1. Faculdade de Medicina da Universidade de Lisboa, 1649-028, Lisbon, Portugal

    Zakhar Shchomak

  2. Department of Ophthalmology, Hospital Santa Maria, Av Prof. Dr. Egas Moniz, 1649-035, Lisbon, Portugal

    David Cordeiro Sousa, Inês Leal & Luís Abegão Pinto

Authors
  1. Zakhar Shchomak
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  2. David Cordeiro Sousa
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  4. Luís Abegão Pinto
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Corresponding author

Correspondence to Luís Abegão Pinto.

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Appendices

Appendix 1. MEDLINE search strategy

  1. 1.

    exp. neovascular glaucoma/

  2. 2.

    ((glaucoma* or angle* or iris or anterior) adj4 neovascular*).tw.

  3. 3.

    (NVG or NVI or NVA).tw.

  4. 4.

    1 or 2 or 3

  5. 5.

    exp. filtering surgery/

  6. 6.

    filtering surgery.tw.

  7. 7.

    glaucoma surgery.tw.

  8. 8.

    trabeculectomy.tw.

  9. 9.

    exp. glaucoma drainage implants/

  10. 10.

    exp. molteno implants/

  11. 11.

    (drainage adj2 (valve or implant or device or shunt)).tw.

  12. 12.

    (ahmed adj2 (valve or implant or device or shunt)).tw.

  13. 13.

    (molteno adj2 (valve or implant or device or shunt)).tw.

  14. 14.

    (krupin adj2 (valve or implant or device or shunt)).tw.

  15. 15.

    exp. angiogenesis inhibitors/

  16. 16.

    (macugen* or pegaptanib* or lucentis* or rhufab* or ranibizumab* or bevacizumab* or avastin* or aflibercept* or eylea*).tw.

  17. 17.

    (anti adj2 VEGF*).tw.

  18. 18.

    (baerveldt adj2 (valve or implant or device or shunt)).tw.

  19. 19.

    5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18

  20. 20.

    4 and 19

  21. 21.

    (animal$ not human$).sh,hw.

  22. 22.

    20 not 21

Appendix 2. EMBASE search strategy

  1. 1.

    exp. neovascular glaucoma/

  2. 2.

    ((glaucoma* or angle* or iris or anterior) adj4 neovascular*).tw.

  3. 3.

    (NVG or NVI or NVA).tw.

  4. 4.

    or/1–3

  5. 5.

    exp. filtering surgery/

  6. 6.

    filtering surgery.tw.

  7. 7.

    glaucoma surgery.tw.

  8. 8.

    trabeculectomy.tw.

  9. 9.

    exp. glaucoma drainage implants/

  10. 10.

    exp. molteno implants/

  11. 11.

    (drainage adj2 (valve or implant or device or shunt)).tw.

  12. 12.

    (ahmed adj2 (valve or implant or device or shunt)).tw.

  13. 13.

    (molteno adj2 (valve or implant or device or shunt)).tw.

  14. 14.

    (baerveldt adj2 (valve or implant or device or shunt)).tw.

  15. 15.

    (krupin adj2 (valve or implant or device or shunt)).tw.

  16. 16.

    exp. angiogenesis inhibitors/

  17. 17.

    (macugen* or pegaptanib* or lucentis* or rhufab* or ranibizumab* or bevacizumab* or avastin* or aflibercept* or eylea*).tw.

  18. 18.

    (anti adj2 VEGF*).tw.

  19. 19.

    or/5–18

  20. 20.

    and/4,19

  21. 21.

    (animal$ not human$).sh,hw.

  22. 22.

    20 not 21

Appendix 3. References to studies excluded from this review

  1. 1.

    Ayyala R, MD F, Zurakowski D, et al. (2002) Comparison of Double-Plate Molteno and Ahmed Glaucoma Valve in Patients With Advanced Uncontrolled Glaucoma. Ophthalmic Surg Lasers 33:94–101.

  2. 2.

    Wang Q (2014) Study on the efficacy between cyclocryotherapy combined trabeculectomy and single cyclocryotherapy for neovascular glaucoma. [Chinese]. Int Eye Sci 14:1638–1640. https://doi.org/10.3980/j.issn.1672-5123.2014.09.23

  3. 3.

    Christakis PG, Tsai JC, Kalenak JW, et al. (2013) The Ahmed Versus Baerveldt Study. Ophthalmology 120:2232–2240. https://doi.org/10.1016/j.ophtha.2013.04.018

  4. 4.

    Ma KT, Yang JY, Kim JH, et al. (2012) Surgical results of ahmed valve implantation with intraoperative bevacizumab injection in patients with neovascular glaucoma. J Glaucoma 21:331–336. https://doi.org/10.1097/IJG.0b013e31820e2fd0

  5. 5.

    Takihara Y, Inatani M, Kawaji T, et al. (2011) Combined intravitreal bevacizumab and trabeculectomy with mitomycin C versus trabeculectomy with mitomycin C alone for neovascular glaucoma. J. Glaucoma 20:196–201.

  6. 6.

    Yang Z, Wang XH, Li RX (2012) Compared analysis of the efficacy of different treatment methods for neovascular glaucoma. Int J Ophthalmol 12:104–106. https://doi.org/10.1016/j.optcom.2009.12.042

  7. 7.

    Li XJ, Hu SQ (2014) Therapeutic effect of modified trabeculectomy in treatment of neovascular glaucoma. [Chinese]. Int Eye Sci 14:745–746. https://doi.org/10.3980/j.issn.1672-5123.2014.04.48

  8. 8.

    Chen C-H, Lai I-C, Wu P-C, et al. (2010) Adjunctive Intravitreal Bevacizumab-Combined Trabeculectomy Versus Trabeculectomy Alone in the Treatment of Neovascular Glaucoma. J Ocul Pharmacol Ther 26:111–118. https://doi.org/10.1089/jop.2009.0055

  9. 9.

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  10. 10.

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  11. 11.

    Teixeira SH, Doi LM, Freitas Silva AL De, et al. (2012) Silicone Ahmed glaucoma valve with and without intravitreal triamcinolone acetonide for neovascular glaucoma: Randomised clinical trial. J Glaucoma 21:342–348. https://doi.org/10.1097/IJG.0b013e31820d7e4e

  12. 12.

    Du Q-W, Yang L-S (2015) Effects of intravitreal injection of Bevacizumab combined with complex trabeculectomy for advanced neovascular glaucoma. Int Eye Sci 15:1766–1768. https://doi.org/10.3980/j.issn.1672-5123.2015.10.24

  13. 13.

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  14. 14.

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  15. 15.

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  16. 16.

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  17. 17.

    Liu XN, Tong FF (2014) Study of surgical treatment on neovascular glaucoma. [Chinese]. Int Eye Sci 14:942–944. https://doi.org/10.3980/j.issn.1672-5123.2014.05.48

  18. 18.

    Syed HM, Law SK, Nam SH, et al. (2004) Baerveldt-350 Implant versus Ahmed Valve for Refractory Glaucoma: A Case-Controlled Comparison. J. Glaucoma 13:38–45.

  19. 19.

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  20. 20.

    Sevim MS, Buttanri IB, Kugu S, et al. (2013) Effect of intravitreal bevacizumab injection before Ahmed glaucoma valve implantation in neovascular glaucoma. Ophthalmologica 229:94–100. https://doi.org/10.1159/000345490

  21. 21.

    Chen JP, Wang R, Xu HY, et al. (2013) Clinical observation of two operation methods for neovascular glaucoma. [Chinese]. Int Eye Sci 13:2259–2261. https://doi.org/10.3980/j.issn.1672-5123.2013.11.28

  22. 22.

    Wu XQ, Guo Y, Gao JL (2016) Curative effect of Ranibizumab with Ex-PRESS drainage device for neovascular glaucoma. [Chinese]. Int Eye Sci 16:300–302. https://doi.org/10.3980/j.issn.1672-5123.2016.2.27

  23. 23.

    Maris PJG, Ishida K, Netland PA (2007) Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap. J. Glaucoma 16:14–19.

  24. 24.

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  25. 25.

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    Mahdy RA, Nada WM, Fawzy KM, et al. (2013) Efficacy of intravitreal bevacizumab with panretinal photocoagulation followed by ahmed valve implantation in neovascular glaucoma. J. Glaucoma 22:768–772.

  28. 28.

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  29. 29.

    Kiddee W, Tantisarasart T, Wangsupadilok B (2012) Neovascular glaucoma: a retrospective review of 5-year experience in Songklanagarind Hospital. J Med Assoc Thai 95 Suppl 4:

  30. 30.

    Yang Z, Wang XH, Li RX (2012) Compared analysis of the efficacy of different treatment methods for neovascular glaucoma. Int J Ophthalmol 12:104–106. https://doi.org/10.1016/j.optcom.2009.12.042

  31. 31.

    Tao SW, Li H, Li J, et al. (2013) Treatment choice of different stages for neovascular glaucoma. Int Eye Sci 13:519–521. https://doi.org/10.3980/j.issn.1672-5123.2013.03.29

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  33. 33.

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  34. 34.

    Zhu Y, Li J, Xu SK (2015) Therapeutic effects of Ex-PRESS glaucoma filtration device implantation in neovascular glaucoma. [Chinese]. Int Eye Sci 15:534–536. https://doi.org/10.3980/j.issn.1672-5123.2015.3.42

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  37. 37.

    Gedde SJ, Heuer DK, Parrish RK (2010) Review of results from the tube versus trabeculectomy study. Curr. Opin. Ophthalmol. 21:123–128.

  38. 38.

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  39. 39.

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  40. 40.

    Wan DH, Zhao Q (2015) Clinical observation of trabeculectomy with mitomycin and interferon therapy on neovascular glaucoma. [Chinese]. Int Eye Sci 15:146–148. https://doi.org/10.3980/j.issn.1672-5123.2015.1.44

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Shchomak, Z., Cordeiro Sousa, D., Leal, I. et al. Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 257, 1079–1089 (2019). https://doi.org/10.1007/s00417-019-04256-8

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