Benefits of a combined surgical technique for patients with secondary neovascular glaucoma

Abstract

Aim: To assess the effectiveness and safety of the proposed surgical technique for treating secondary neovascular glaucoma. Materials and Methods: We examined 28 eyes of 28 patients (16 women and 12 men), aged 46±7,2 years, with secondary neovascular glaucoma. All patients underwent a comprehensive ophthalmological examination before and during treatment. Two-stage treatment was applied to all patients. At the first stage – performed an advanced technique of non-penetrating deep sclerectomy while administering anti-VEGF (anti-vascular endothelial growth factor) intravitreal or intracameral injections. At the second – we performed externalization of Schlemm’s canal followed by YAG laser trabeculectomy. Statistical analysis of the results was used the SPSS v. 11.0, MedStat v.15.1 software package for medical and biological research. Results: The proposed surgical technique, leads to a gradual decrease in intraocular pressure (IOP) and regression of the iris and anterior chamber angle neovascularization. The postoperative course was uneventful for all the patients. In the early ostoperative period, the IOP was observed to be normalized in all the eyes. The IOP ranged from 12 to 16 mm Hg. The neovascularization regression occurred (in 100 % of cases) within 5-7 days. Conclusions: Gradual reduction of IOP reduces intraoperative complications. Intravitreal or intracameral injections of anti-proliferative agents contribute to the regression of neovascularization and further gradual reduction of IOP. Performing a laser trabeculectomy in the area where a non-penetrating deep sclerectomy was previously performed creates new pathways for the outflow of intraocular fluid from the anterior chamber and reduces the risks of reintervention.