Abstract
BackgroundThe authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD).MethodsThis was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision.ResultsOne hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation.ConclusionsIn our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.
Highlights
The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD)
With an aim to close these knowledge gaps, we reviewed the medical records of NVG patients treated with GDD to determine the outcomes in patients with proliferative diabetic retinopathy (PDR), retinal vein occlusion (RVO), and other etiologies 1 year after glaucoma surgery
The University of Miami Clinical and Translational Science Institute performed an electronic review of data from our hospital electronic medical record (EMR) (EPIC Systems Corporation, Verona WI) to identify all patients with a diagnosis of NVG presenting to the Bascom Palmer Eye Institute / Anne Bates Leach Eye Hospital between 9/1/2011 through 5/1/19 with an ICD-9 or ICD-10 diagnosis of neovascular glaucoma
Summary
The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD). The prevalence of NVG is estimated at 52 per 100,000 in a recent nationwide population based database study in Taiwan with an observed increase in the percentage of patients receiving anti-vascular endothelial growth factor (anti-VEGF) treatments and a decrease in the incidence. Diabetic retinopathy, one of the leading causes of NVG, was found to be the 5th most frequent cause of blindness in those aged 50 years and older in 2020 according to a recent analysis for the Global Burden of Disease Study [5]. High rates of failure with conventional trabeculectomy surgery [8,9,10] have led to increased use of GDD for treatment of NVG [7, 10, 11]. Vision outcomes are thought to be poor for NVG [12], but most studies have used a limited definition of success including not progressing to no light perception (NLP) vision [13, 14]
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