Abstract
Background
Treatment of neovascular glaucoma (NVG) must be focused on the reduction of intraocular pressure (IOP) and prompt application of pan retinal photocoagulation (PRP). A combination of complete PRP during vitrectomy with trabeculectomy should theoretically be a better method to lower the IOP rapidly in eyes with NVG. The purpose of our study is to assess the efficacy of combining pars plana vitrectomy and PRP with trabeculectomy assisted by mitomycin C (MMC) on NVG eyes secondary to diabetic retinopathy.
Methods
Twenty-five eyes with NVG associated with diabetic retinopathy had pars plana vitrectomy, followed by PRP and trabeculectomy with MMC. The eyes were divided into two groups: nine eyes with vitreous hemorrhage, fibrovascular membrane and/or retinal detachment were placed in the Proliferation group; and 16 eyes without vitreous hemorrhage, fibrovascular membrane, or retinal detachment were placed in the PC (photocoagulation) group. These eyes had vitrectomy performed so that PRP could be safely performed from ora to ora. The surgical outcome in the two groups was assessed by Kaplan-Meier survival analysis. The criteria for success were a postoperative intraocular pressure (IOP) ≤21 mmHg and a preservation of light perception.
Results
In the Proliferation group, Kaplan-Meier life-table analysis showed that the success rate was 55.6% after 1 year and 18.5% after 2 years. The success rate in the PC group was 81.2% from 1 to 3 years after surgery. The surgical outcome was significantly better in the PC group than in the Proliferation group (P=0.009). In the Proliferation group, four eyes had preoperative vitreous hemorrhage, three eyes had a fibrovascular membrane, and two eyes had a retinal detachment. Three of four eyes with vitreous hemorrhage achieved good IOP control. On the other hand, the IOP of all eyes with retinal detachment and fibrovascular membrane were not lowered significantly.
Conclusions
Complete PRP combined with trabeculectomy with MMC can effectively reduce the elevated IOP in eyes with NVG. However, this combined treatment is not effective in eyes with proliferative membranes and retinal detachments.
Similar content being viewed by others
References
Bartz-Schmidt KU, Thumann G, Psichias A, Krieglstein GK, Heimann K (1999) Pars plana vitrectomy, endolaser coagulation of the retina and the ciliary body combined with silicone oil endotamponade in the treatment of uncontrolled neovascular glaucoma. Graefe’s Arch Clin Exp Ophthalmol 237:969–975
Brown GC, Magargal LE, Schachat A, Shah H (1984) Neovascular glaucoma: etiologic considerations. Ophthalmology 91:315–320
Hyung SM, Kim SK (2001) Mid-term effects of trabeculectomy with mitomycin C in neovascular glaucoma patients. Korean J Ophthalmol 15:98–106
Katz GH, Higginbotham EJ, Lichiter PR, Skuta GL, Musch DC, Bergstrom TJ, Johnson AT (1995) Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology 102:1263–1269
Kitazawa Y, Kawase K, Matsushita H, Minobe M (1991) Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol 109:1693–1698
Kono T, Shiga S, Takesue Y, Sakamoto T (2005) Long-term results of pars plana vitrectomy combined with filtering surgery for neovascular glaucoma. Ophthalmic Surg Lasers Imaging 36:211–216
Lloid MA, Heuer DK, Baerveldt G, Minckler DS, Martone JF, Lean JS, Liggett PE (1991) Combined Molteno implantation and pars plana vitrectomy for neovascular glaucomas. Ophthalmology 98:1401–1405
Ohnishi Y, Ishibashi T, Sagawa T (1994) Fluorescein gonioangiography in diabetic neovascularization. Graefe’s Arch Clin Exp Ophthalmol 232:199–204
Rockwood EJ, Parrish RK 2nd, Heuer DK, Skuta GL, Hodapp E, Palmberg PF, Gressel MG, Feuer W (1987) Glaucoma filtering surgery with 5-fluorouracil. Ophthalmology 94:1071–1078
Sivak-Callcott JA, O’Day DM, Gass JD, Tsai JC (2001) Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology 108:1767-1776
Tsai JC, Feuer WJ, Parrish RK 2nd, Grajewski AL (1995) 5-Fluorouracil filtering surgery and neovascular glaucoma. Long-term follow-up of the original pilot study. Ophthalmology 102:887–892
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kiuchi, Y., Nakae, K., Saito, Y. et al. Pars plana vitrectomy and panretinal photocoagulation combined with trabeculectomy for successful treatment of neovascular glaucoma. Graefe's Arch Clin Exp Ophthalmol 244, 1627–1632 (2006). https://doi.org/10.1007/s00417-006-0321-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-006-0321-7