Neovascular glaucoma （NVG） is a blinding, intractable disease, which is difficult to manage. It is referred to as an ＂end-stage＂ ocular disease. Conventional treatments for extremely uncontrolled NVG cases include retinal cryotherapy or enucleation. Major advancements in the diagnosis and the treatment of NVG, such as glaucoma drainage implant surgery and anti-vascular endothelial growth factor （anti-VEGF） treatment, have led to a new era in the management of this condition. However, many challenges still remain to be overcome.
Background Neovascular glaucoma is a refractory disease, and difficult to manage. The aim of this study was to evaluate the clinical outcomes of Ahmed glaucoma valve implantation （AGVI） in neovascular glaucoma （NVG） and non- NVG patients. Methods This prospective, non-randomized study included 55 eyes of 55 patients with refractory glaucoma; 27 had NVG （NVG group） and 28 had non-NVG （non-NVG group）. All of the patients underwent AGVI. The NVG group was adjunctively injected with intravitreal ranibizumab/bevacizumab （IVR/IVB） before AGVI. Intraocular pressure （lOP） was the primary outcome measure in this study. Surgical success rate, number of antiglaucoma medications used, best corrected visual acuity （BCVA）, and postoperative complications were analyzed between the groups. Results All of the patients completed the study （follow-up of 12 months）. Kaplan-Meier survival curve analysis indicated that the qualified success rates in the NVG and non-NVG groups at 12 months were 70.5% and 92.9%, respectively; this difference was significant （P=-0.036）. The complete success rates in the NVG and non-NVG groups at 12 months were 66.7% and 89.3%, respectively （P=0.049）. Compared with preoperative examinations, the postoperative mean lOP and use of medications were significantly lower at all follow-up time points in both groups （all P 〈0.05）. There were significant differences in BCVA between the two groups at the 12-month follow-up （X2=9.86, P=0.020）. Cox proportional hazards regression showed NVG as a risk factor for surgical failure （RR=15.08, P=0.033）. Postoperative complications were similar between the two groups. Conclusions AGVI is a safe and effective procedure in refractory glaucoma, but the success rate of surgery was related to the type of refractory glaucoma. The complete and qualified success rates of NVG patient adjunctive anti-vascular endothelial growth factor treatment are still lower than those of non-NVG patients.
Li ZhengZhou MinwenWang WeiHuang WenbinChen ShidaLi XingyiGao XinboZhang Xiulan
