Comparison of the safety and efficacy of triple sequential therapy and transscleral cyclophotocoagulation for neovascular glaucoma in the angle-closure stage

Ying Hong,Hongliang Dou,Zhizhong Ma,Chun Zhang,Yuntao Hu,Changguan Wang

doi:10.1038/s41598-018-25394-9

Abstract

To compare the efficacy and safety of triple therapy combining intravitreal injection of anti-vascular endothelial growth factor, trabeculectomy, and pan-retinal photocoagulation via binocular indirect ophthalmoscopy, with that of transscleral cyclophotocoagulation (TCP) to treat neovascular glaucoma in the angle-closure stage. Eighteen triple therapy patients and 25 TCP patients between May 2014 and May 2016 were retrospectively analysed. Anterior chamber puncture and anti-VEGF intravitreal injection were performed on the first day of sequential therapy. Trabeculectomy was performed 3–5 d after injection; pan-retinal laser photocoagulation via binocular indirect ophthalmoscopy was initiated 5–7 d later. The IOP of the triple therapy group was lower than that of the TCP group (15.2 ± 2.2 vs. 20.0 ± 8.5 mmHg) and fewer anti-glaucoma drugs were used (0.5 ± 1.0 vs. 0.6 ± 1.0) after treatment. The success rates of the two groups were 89% and 60% respectively (P = 0.032). The visual function of 94% of triple therapy patients was preserved or improved compared to 64% of TCP patients with statistical significance (P = 0.028). No patient in the triple therapy group showed hypotony or eyeball atrophy. Compared to TCP, triple therapy shows higher success rate, fewer complications, and attributes to visual function preservation.

Highlights

Neovascular glaucoma (NVG) is a type of refractory glaucoma, which is usually secondary to retinal ischemia
The post-treatment intraocular pressure (IOP) and number of anti-glaucoma drugs used were slightly lower in the triple sequential therapy group than in the transscleral cyclophotocoagulation (TCP) group, the difference was not significant (t = 1.984, P = 0.056 and t = 0.050, P = 0.961, respectively; Table 1)
The current study compared the efficacy between the triple sequential therapy and TCP for treating NVG in the angle-closure stage

Summary

Introduction

Neovascular glaucoma (NVG) is a type of refractory glaucoma, which is usually secondary to retinal ischemia. The vascular endothelial growth factor (VEGF) released after retinal ischemia will result in neovascularization of the iris and anterior chamber angle. The angle closure stage of neovascular glaucoma is the terminal stage of the disease, a considerable number of patients retain some visual function at this stage. An injection of anti-vascular endothelial growth factor (anti-VEGF) has been reported to alleviate the symptoms and result in short-term control of intraocular pressure, which may enable additional measures to be employed for IOP control and treatment of retinal ischaemia. We devised a combination therapy, known as triple sequential therapy, comprising intravitreal injection of anti-VEGF and trabeculectomy to control IOP, and pan-retinal photocoagulation (PRP) under indirect ophthalmoscopy. We compared the efficacy and complications between the triple sequential therapy and TCP for the treatment of NVG at the angle-closure stage

Methods

Results

Conclusion