Abstract
Purpose To compare the outcomes of Ex-PRESS glaucoma filtration device and transscleral cyclophotocoagulation (TSCP) in the management of neovascular glaucoma (NVG). Patients and Methods. A total of 30 eyes (12 express shunts and 18 TSCP) of 28 patients were included. The eyes had NVG with intraocular pressure (IOP) more than 21 mmHg of the maximally tolerated medication treatment after previous panretinal photocoagulation and antivascular endothelial growth factor (anti-VEGF) injection, with no previous history of a cyclodestruction procedure or glaucoma surgery, were randomized either for Ex-PRESS glaucoma filtration device or TSCP. The patients were followed up weekly for the first month and then monthly for 12 months as regard to the IOP, number of topical antiglaucoma drugs required, visual outcome, and postoperative complications. Results IOP was successfully controlled with both techniques in 83.3% of the eyes. Both techniques had fewer complications and required fewer subsequent procedures. Conclusion Both the Ex-PRESS glaucoma filtration device and TSCP might constitute safe and alternative therapeutic tools for patients with NVG. However, TSCP is an easier procedure, less time consuming, and does not require a learning curve.
Highlights
Neovascular glaucoma (NVG) is a refractory glaucoma that often results in loss of vision despite aggressive management
Numerous interferences and medications have been used for the control of raised intraocular pressure (IOP) in NVG, but no definite therapeutic tool has been recognized as the most effective armamentarium [1]
Glaucoma drainage devices are commonly and effectively used in the surgical treatment of NVG [6]. e ExPRESS glaucoma filtration device (Alcon Laboratories, Fort Worth, TX) is a nonvalved stainless steel implant that drains aqueous humor from the anterior chamber into the subconjunctival space and has been used as an alternative to trabeculectomy [7]. e Ex-PRESS glaucoma filtration device has the advantage of being less traumatic than traditional trabeculectomy as it does not require a sclerectomy or peripheral iridectomy [8]
Summary
Neovascular glaucoma (NVG) is a refractory glaucoma that often results in loss of vision despite aggressive management. We included 28 patients aged between 35 and 55 years old with a clinical diagnosis of NVG and IOP greater than 21 mmHg despite maximal medical treatment. Patients were randomized for the Ex-PRESS glaucoma filtration device; 12 eyes of 12 patients (group A) underwent the procedure in the operating room under either regional anesthesia (peribulbar block with 2% lidocaine) or general anesthesia. E laser procedure was repeated if necessary, leaving at least 4 weeks between every session, until either the IOP was ≤ 21 mmHg or a total of five sessions had been reached Both groups were followed up weekly for the first month and monthly for at least 12 months with regards to their IOP, number of topical antiglaucoma drugs required, bestcorrected visual acuity (BCVA), and postoperative complications
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