Abstract
PurposeTo evaluate long-term outcomes and identify prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma.MethodsSixty-one eyes of 54 patients with neovascular glaucoma treated by trabeculectomy following intraocular bevacizumab injection were consecutively enrolled. Surgical success criteria were sufficient intraocular pressure (IOP) reduction (IOP ≤21 mmHg, ≥20% IOP reduction, no additional medications or glaucoma surgeries) without devastating complications (loss of light perception, phthisis bulbi, and endophthalmitis) or significant hypotony (IOP ≤5 mmHg continued ≥6 months and until the last follow-up visit or hypotony requiring intervention). Kaplan-Meier survival curves and Cox regression analysis were used to examine success rates and risk factors for surgical outcomes.ResultsThe follow-up period after trabeculectomy was 45.0 ± 22.2 months (mean ± standard deviation). Surgical success rate was 86.9 ± 4.3% (± standard error), 74.0 ± 6.1%, and 51.3 ± 8.6% at 1, 3, and 5 years. Multivariate Cox regression analysis identified two risk factors; lower preoperative IOP (≤30 mmHg) for surgical failure and hypotony [hazard ratio (HR), 2.92, 6.64; 95% confidence interval (CI), 1.22 to 7.03, 1.47 to 30.0; P = 0.018, 0.014, respectively], and vitrectomy after trabeculectomy for surgical failure with or without hypotony criteria (HR, 2.32, 4.06; 95% CI, 1.02 to 5.28, 1.30 to 12.7; P = 0.045, 0.016, respectively).ConclusionsThe long-term outcomes of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma were favorable. Lower baseline IOP was associated with development of significant hypotony, while additional vitrectomy was related to insufficient IOP reduction.
Highlights
Neovascular glaucoma (NVG) is a refractory type of secondary glaucoma caused by neovascularization which occludes the trabecular meshwork
Multivariate Cox regression analysis identified two risk factors; lower preoperative intraocular pressure (IOP) (30 mmHg) for surgical failure and hypotony [hazard ratio (HR), 2.92, 6.64; 95% confidence interval (CI), 1.22 to 7.03, 1.47 to 30.0; P = 0.018, 0.014, respectively], and vitrectomy after trabeculectomy for surgical failure with or without hypotony criteria (HR, 2.32, 4.06; 95% CI, 1.02 to 5.28, 1.30 to 12.7; P = 0.045, 0.016, respectively)
Lower baseline IOP was associated with development of significant hypotony, while additional vitrectomy was related to insufficient IOP reduction
Summary
Neovascular glaucoma (NVG) is a refractory type of secondary glaucoma caused by neovascularization which occludes the trabecular meshwork. Risk factors for surgical failure of trabeculectomy in eyes with NVG include younger age [2,4], previous pars plana vitrectomy (PPV) [3,4], extensive peripheral anterior synechia [3], pseudophakia [5] and postoperative hyphema [6]. Vascular endothelial growth factor (VEGF), derived from ischemic retinal pathologies, was identified as the main causative molecule for anterior segment neovascularization in NVG [7,8], and intraocular injection of anti-VEGF agents has been proposed as a promising therapy for NVG. Tube shunt surgeries have gained popularity as the first choice surgery in complex cases including NVG, trabeculectomy with adjunctive anti-VEGF injections may work well for NVG
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