Abstract
BackgroundThe aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG).MethodsFifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5 mg/0.05 ml) treatment followed by trabeculectomy and panretinal photocoagulation. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-β1 and PLGF in aqueous humour samples collected during surgery were measured by enzyme-linked immunosorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed in 2 eyes, and light microscopy was used as the histopathological control.ResultsThe follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 completed 1 year of follow-up, and 13 were lost to follow-up. Recurrence of iris neovascularization was observed in 5 eyes, 9 had hyphema, 16 had filter-bled scarring, and no eye had complications attributable to the drug. The mean IOP was reduced from 48.1 ± 14.2 to 23.2 ± 8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) after 1 year (both P < 0.05). The complete success rate was 76.9, 76.9, 71.0, 51.6, and 32.3% at 1 week, 1 month, 3 months, 6 months and 12 months, respectively, when the cut-off IOP was 18 mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-β1 in the aqueous humour in NVG patients decreased from 168.8 ± 13.4 and 159.6 ± 15.4 pg/ml to 160.2 ± 7.6 and 151.9 ± 2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens treated with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cell degeneration in the conbercept-treated specimens.ConclusionsOur initial findings suggest that intravitreal conbercept is an effective treatment for managing NVG that has fewer short-term postoperative complications.Trial registrationCurrent Controlled Trials ChiCTR1800019918, 8 December 2018, retrospectively registered.
Highlights
The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG)
Neovascular glaucoma (NVG) is a refractory glaucoma caused by retinal ischaemic disease, such as central retinal vein occlusion (CRVO), diabetic retinopathy (DR), and ocular ischaemic syndrome, and is characterized by neovascularization of the iris and anterior chamber angle and high intraocular pressure (IOP) [1]
The IOP of 5 eyes with previously uncontrolled IOP was controlled by transscleral cyclophotocoagulation (TCP) or trabeculectomy
Summary
The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG). Using anti-glaucoma drugs or panretinal photocoagulation (PRP) may be effective in the early rubeosis iridis and open-angle glaucoma stages. In the angle-closure glaucoma stage of NVG, IOP increases rapidly because proliferative fibrovascular membranes cause angle closure; glaucoma-filtering surgery is effective, but its success rate is poor due to iris and anterior chamber angle neovascularization. Intravitreal injection of anti-VEGF agents, such as bevacizumab and ranibizumab combined with glaucoma-filtering surgery, and PRP has been shown to rapidly regress iris neovascularization and to effectively reduce IOP [3, 4]
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