A Clinical Study On Systematical Treatment For Neovascular Glaucoma

Objective: To evaluate the effect of combinational methods in the systematical treatment of neovascular glaucoma.Method: 16 patients of neovascular glaucoma who remain part of visual function treated with AGV(Ahmed glaucoma value) implantation after totally or partially regression of iris neovessels with the treatment of ocular hypotensive agents and intravitreal anti-VEGF medicine. Accompany with phacoemulsification + IOL implantation(7 cases), vitrectomy + retinal photocoagulation(1 case), combine with phacoemulsification + IOL implantation and vitrectomy + retinal photocoagulation(2cases) according to the refractive media situation during operation.Finally, panretinal photocoagulation(2-4 times) was added on the basis of retina evaluation for those who without retinal photocoagulation during operation. Cases were followed up for 1、2、3d, 1、2、3w, 1、3、6、12、18m with best-corrected visual acuity, IOP(Lowering intraocular), regression of iris neovessels,complications and success rate after surgery.Results: Iris neovessel regressed completely in 14 cases and regressed partially in 2 cases within 1 week after intravitreal anti-VEGF medicine. The postoperative best-corrected visual acuity improved in 12 cases, stable in 4 cases. At final follow-up, the IOP of 13 cases were controlled in normal level without any drugs and of 3 cases with anti-glaucoma drugs(the IOP of 2 cases were less than 21 mmHg and one was more than 21mmHg) after surgery. The mean IOP has dropped from(47.5 ± 8.82)mmHg preoperatively to(18.05±4.65)mmHg postoperatively. IOP reduction was statistically different between preoperative and postoperative(P<0.05). The common postoperative complications including lower intraocular pressure, shallow anterior chamber, transient high intraocular pressure and filtration tissue fibrosis in late stage, without any sever complications during the whole treatment.Conclusion: 1. Lowering intraocular pressure timely and effectively for the treatment of hypotensive agents before the operation, can create better operation condition of preserving resident visual function; 2. Intravitreal anti-VEGF medicine preoperatively can inhibit Iris neovessel effectively in the early stage and reduce bleeding during operation, contribute to favorable situation for Ahmed glaucoma drainage value implantation; 3. AGV(Ahmed glaucoma) value implantation combine with operation of removing turbid refractive media situation can improve visual function better; 4. Panretinal photocoagulation intraoperatively and postoperatively decrease neovessels recurrence and improve success rate of operation for a long time; 5. The apply of demountable suture during operation reduced the occurrence rate of lower intraocular pressure in early stage and shallow anterior chamber; 6. Combining various methods in the systematical treatment of neovascular glaucoma is synthetical and effective in the treatment of neovascular glaucoma. It has improved the success rate of surgery and preserves resident visual function with less complications but also contributes to open up new roads in neovascular glaucoma treatment.