OBJECTIVE: To review causes, treatment modalities, and success of neovascular glaucoma treatment in the past five years at Songklanagarind Hospital. MATERIAL AND METHOD: Neovascular glaucoma of any causes between February 2005 and January 2010 were retrospectively reviewed. The patients were divided into six major treatment subgroups. A medical treatment group, an intraocular bevacizumab injection group (IOB), a trabeculectomy with mitomycin C group, a trabeculectomy with mitomycin C plus adjunctive intraocular bevacizumab injection group, a glaucoma drainage device group, and a transscleral cyclophotocoagulation group. All treatment outcomes were compared and classified as success or failure according to the specific criteria. RESULTS: One hundred and sixty-six eyes were reviewed. The mean age at the time of diagnosis was 60 +/- 16 years and the average follow-up duration was 21 +/- 18 months. The most common etiology was central retinal vein occlusion (47%) followed by proliferative diabetic retinopathy (42%) and ocular ischemic syndrome (5%). The mean pressure was reduced from 38.1 +/- 12.5 mmHg at baseline to 17.8 +/- 12.3 mmHg at the final visit. After treatment, visual acuity was worse, remained stable, and improved in 45%, 37%, and 18% of the patients, respectively. In the trabeculectomy with mitomycin C plus intraocular bevacizumab injection group 54% of eyes were classified as a complete success, which was significantly higher than the other groups (p < 0.001). Although filtering surgeries with adjunctive bevacizumab showed no benefit over standard filtering surgeries in terms of VA change, pressure reduction, and success criteria but complications were found to be less in eyes treated with adjuvant bevacizumab. CONCLUSION: Key factors are treatment of the underlying disease responsible for ischemic triggers and treatment of the increased intra-ocular pressure. Even treatment with bevacizumab cannot increase the success rate but this seems to reduce the surgical complications.
OBJECTIVE: To review causes, treatment modalities, and success of neovascular glaucoma treatment in the past five years at Songklanagarind Hospital. MATERIAL AND METHOD:Neovascular glaucoma of any causes between February 2005 and January 2010 were retrospectively reviewed. The patients were divided into six major treatment subgroups. A medical treatment group, an intraocular bevacizumab injection group (IOB), a trabeculectomy with mitomycin C group, a trabeculectomy with mitomycin C plus adjunctive intraocular bevacizumab injection group, a glaucoma drainage device group, and a transscleral cyclophotocoagulation group. All treatment outcomes were compared and classified as success or failure according to the specific criteria. RESULTS: One hundred and sixty-six eyes were reviewed. The mean age at the time of diagnosis was 60 +/- 16 years and the average follow-up duration was 21 +/- 18 months. The most common etiology was central retinal vein occlusion (47%) followed by proliferative diabetic retinopathy (42%) and ocular ischemic syndrome (5%). The mean pressure was reduced from 38.1 +/- 12.5 mmHg at baseline to 17.8 +/- 12.3 mmHg at the final visit. After treatment, visual acuity was worse, remained stable, and improved in 45%, 37%, and 18% of the patients, respectively. In the trabeculectomy with mitomycin C plus intraocular bevacizumab injection group 54% of eyes were classified as a complete success, which was significantly higher than the other groups (p < 0.001). Although filtering surgeries with adjunctive bevacizumab showed no benefit over standard filtering surgeries in terms of VA change, pressure reduction, and success criteria but complications were found to be less in eyes treated with adjuvant bevacizumab. CONCLUSION: Key factors are treatment of the underlying disease responsible for ischemic triggers and treatment of the increased intra-ocular pressure. Even treatment with bevacizumab cannot increase the success rate but this seems to reduce the surgical complications.