English

Abstract

AIM OF THE STUDY: 1. To analyze about comparative effect of Trabeculectomy with Mitomycin C/ Trabeculectomy with Ologen implant/ Glaucoma drainage device surgery in 25 cases of Neovascular glaucoma. 2. To find out best method, control of intraocular pressure, visual outcome, post operative complications. 3. To find out the etiological factors, mode of presentation and associated systemic conditions. METHODS: In this pilot study, 25 patients of neovascular glaucoma were selected, evaluated and divided into 3 groups. Group 1: 10 patients were treated with Trabeculectomy with Mitomycin C. Group 2: 10 patients were treated with Trabeculectomy with Ologen implant. Group 3 : 5 patients were treated with drainage device surgery. All patients were re- examined first post operative day and then end of first week, 6 week and 12week. The control of intraocular pressure, visual outcome, post operative complications were assessed. Effect of different methods of treatment compared and best method of treatment was analysed. RESULTS: The major aetiological factors causing Neovascular glaucoma are proliferative diabetic retinopathy, central retinal vein occlusion, recurrent anterior uveitis. The mean age of presentation was 59.04 years with male preponderance. Neovascular glaucoma secondary to Central Retinal Vein Occlusion presented earlier than proliferation diabetic retinopathy which was presented relatively later. At most cases had corneal and iris involvement with new vessels extending into the angle with or without synechial angle closure. The mean pre treatment intra ocular pressure was 45.76mmHg. among the three modalities of treatment maximum mean reduction of IOP in the first week was seen in group III (drainage implant surgery). But at the end of 12 weeks of follow up all three groups showed statistically significant reduction of mean IOP. There is no significant gross difference between these groups at the end of 12 weeks. Group I -Trabeculectomy with Mitomycin - c showed more complication compare to other 2 groups, shallow anterior chamber and bleb related complications more common in group I. Group II- Trabeculectomy with ologen implant showed minimal complications.In Group III- drainage device surgery patients had complications like hyphaema, tube contact with cornea and pain intra operative bleeding is more common in neo vascular glaucoma patients. CONCLUSION: At the end of 12 weeks of follow up all three groups showed statistically significant reduction of mean IOP. There is no significant gross difference between these groups at the end of 12 weeks.In severely compromised eyes with Neovascular glaucoma, the main advantage of Keiki Metha Valve implantation is pain relief and avoidance of enucleation in addition to a significant reduction in intra ocular pressure. If the patients would have presented earlier and managed appropriately, this much dreaded complication of painful Neovascular glaucoma could be avoided earlier.