J Korean Ophthalmol Soc.  2016 Apr;57(4):607-613. 10.3341/jkos.2016.57.4.607.

Intravitreal Bevacizumab and Subsequent Trabeculectomy with Mitomycin C for Neovascular Glaucoma with Previous Sutureless Vitrectomy

Affiliations
  • 1Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea. alertlee@naver.com
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE
To evaluate the efficacy of intravitreal bevacizumab and subsequent trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG) in eyes that underwent previous 23-gauge transconjunctival sutureless vitrectomy (TSV).
METHODS
This was a retrospective, comparative, and consecutive case series study. We reviewed the medical records of patients with NVG who underwent trabeculectomy with MMC after intravitreal bevacizumab (1.25 mg/0.05 mL) injection and compared the surgical outcomes according to 23-gauge TSV history. Surgical success was defined as an intraocular pressure (IOP) of ≥6 mm Hg and ≤21 mm Hg without additional glaucoma surgery or loss of light perception. The main outcome measures were postoperative IOP control, visual acuity, and complications.
RESULTS
A total of 27 patients (27 eyes) were included; 12 patients with 23-gauge TSV history (TSV group) and 15 patients without vitrectomy history (nonvitrectomized group). The cumulative probability of success after trabeculectomy with MMC was 82.5% and 73.3% after one year for the TSV group and the nonvitrectomized group, respectively (p = 0.523). Mean IOP decreased from 37.3 ± 9.0 mm Hg preoperatively to 12.8 ± 6.2 mmHg at the final visit in the TSV group (p = 0.002). Mean IOP decreased from 40.3 ± 9.7 mm Hg preoperatively to 17.8 ± 11.7 mm Hg at the final visit in the nonvitrectomized group (p = 0.001). Preoperative and final IOP were not significantly different between the two groups. Complications were comparable between the groups.
CONCLUSIONS
Intravitreal bevacizumab injection and subsequent trabeculectomy with MMC is an effective method for controlling IOP in patients with NVG associated with sutureless vitrectomy.

Keyword

Intravitreal bevacizumab injection; Neovascular glaucoma; Trabeculectomy with mitomycin C; Transconjuctival sutureless vitrectomy

MeSH Terms

Glaucoma
Glaucoma, Neovascular*
Humans
Intraocular Pressure
Medical Records
Mitomycin*
Outcome Assessment (Health Care)
Retrospective Studies
Trabeculectomy*
Visual Acuity
Vitrectomy*
Mitomycin

Figure

  • Figure 1. Changes in mean IOP after intravitreal bevacizumab injection and trabeculectomy with MMC. IOP at each time point was not significantly different between the two groups during the entire study period. The figures indicate the number of patients followed-up at the time (nonvitrectomized group/TSV group). The error bars are 95% confidence intervals (mean ± SE × 1.96). IOP = intraocular pressure; MMC = mitomycin C; TSV = transconjunctival sutureless vitrectomy; SE = standard error; Pre-OP = preoperative.

  • Figure 2. Cumulative probabilities of surgical success after intravitreal bevacizumab injection and subsequent trabeculectomy with MMC in the TSV group (solid line) and nonvitrectomized group (dotted line). The success rate was not statistically significantly different between the two groups (p = 0.523; Mantel-Cox log rank test). The figures under the horizontal axis represent the number of patients followed-up at the noted time (nonvitrectomized group/TSV group). MMC = mitomycin C; TSV = transconjunctival sutureless vitrectomy.


Reference

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