Neovascular Glaucoma After Vitrectomy
Neovascular Glaucoma After Vitrectomy
In total, 512 patients (512 eyes) fulfilled the study criteria. All patients were Japanese and their baseline characteristics are shown in Table 1. The mean follow-up period in all cases was 422 days (range, 1 to 2580 d). Vitrectomy of PDR eyes was performed to treat the following vitreoretinal complications: loss of vision due to vitreous hemorrhage (455 eyes), tractional retinal detachment (22 eyes), and visual disturbance due to fibrovascular proliferation (35 eyes).
In total, 27 of the 512 patients (5.3%) developed NVG after vitrectomy. The mean period between vitrectomy and development of NVG was 151 days (range, 50 to 530 d). In 9 of the 27 eyes (33%), IOP was controlled to 21 mm Hg or lower with the administration of antiglaucoma drugs. Fifteen of the 27 eyes (56%) required an additional surgical treatment to reduce IOP. Of these 15 eyes, 14 and 1 eye underwent filtering surgery and an additional vitrectomy, respectively. The remaining 3 patients refused an additional surgical treatment for IOP elevation (Table 2).
Kaplan-Meier survival analysis revealed that the probability of NVG occurrence after vitrectomy at 6, 12, 24, and 36 months was 6.0%, 7.1%, 8.7%, and 8.7%, respectively (Fig. 1). The Cox proportional hazards model identified that male sex (RR=4.247; P = 0.0032), younger age (RR=0.956/y; P = 0.0237), higher baseline IOP (RR=1.203/mm Hg; P = 0.0335), preoperative neovascularization in the anterior chamber angle (RR=8.899; P < 0.0001), and NVG in the fellow eye (RR=5.355; P = 0.0013) were significant risk factors for the development of NVG after vitrectomy. Thirteen of the 38 patients (34.2%) with preoperative neovascularization in the anterior chamber developed NVG after vitrectomy, representing 48.1% in postoperative NVG.
(Enlarge Image)
Figure 1.
Estimated cumulative probability of neovascular glaucoma (NVG) development after vitrectomy for proliferative diabetic retinopathy, as calculated by Kaplan-Meier survival analysis. Subjects are 512 eyes.
Results
In total, 512 patients (512 eyes) fulfilled the study criteria. All patients were Japanese and their baseline characteristics are shown in Table 1. The mean follow-up period in all cases was 422 days (range, 1 to 2580 d). Vitrectomy of PDR eyes was performed to treat the following vitreoretinal complications: loss of vision due to vitreous hemorrhage (455 eyes), tractional retinal detachment (22 eyes), and visual disturbance due to fibrovascular proliferation (35 eyes).
In total, 27 of the 512 patients (5.3%) developed NVG after vitrectomy. The mean period between vitrectomy and development of NVG was 151 days (range, 50 to 530 d). In 9 of the 27 eyes (33%), IOP was controlled to 21 mm Hg or lower with the administration of antiglaucoma drugs. Fifteen of the 27 eyes (56%) required an additional surgical treatment to reduce IOP. Of these 15 eyes, 14 and 1 eye underwent filtering surgery and an additional vitrectomy, respectively. The remaining 3 patients refused an additional surgical treatment for IOP elevation (Table 2).
Kaplan-Meier survival analysis revealed that the probability of NVG occurrence after vitrectomy at 6, 12, 24, and 36 months was 6.0%, 7.1%, 8.7%, and 8.7%, respectively (Fig. 1). The Cox proportional hazards model identified that male sex (RR=4.247; P = 0.0032), younger age (RR=0.956/y; P = 0.0237), higher baseline IOP (RR=1.203/mm Hg; P = 0.0335), preoperative neovascularization in the anterior chamber angle (RR=8.899; P < 0.0001), and NVG in the fellow eye (RR=5.355; P = 0.0013) were significant risk factors for the development of NVG after vitrectomy. Thirteen of the 38 patients (34.2%) with preoperative neovascularization in the anterior chamber developed NVG after vitrectomy, representing 48.1% in postoperative NVG.
(Enlarge Image)
Figure 1.
Estimated cumulative probability of neovascular glaucoma (NVG) development after vitrectomy for proliferative diabetic retinopathy, as calculated by Kaplan-Meier survival analysis. Subjects are 512 eyes.
