combined surgery for neovascular angle-closure glaucoma secondary to proliferative diabetic retinopathy

METHODS:A prospective nonrandomized clinical study was performed. All enrolled patients were initially treated with intravitreal injection of ranibizumab at the dose of 0.5mg(0.05mL). After new vessels(NV)on the iris and the angle of anterior chamber regressed completely, all patients received phacoemulsification(PHACO), intraocular lens implantation(IOL), trabeculectomy(TRAB), pars plana vitrectomy(PPV)and endophotocoagulation(EPC). The changes of best corrected visual acuity(BCVA), intraocular pressure(IOP), NV and complications were observed, and followed up for 6mo.

RESULTS:Nineteen eyes of 19 patients with neovascular glaucoma(NVG)were involved in this study. After followed up for 6mo, postoperative BCVA of all was improved. Mean IOP was decreased significantly(P<0.01)from 60.00±6.98mmHg preoperatively to 9.68±2.11mmHg at 1wk, 13.32±2.38mmHg at 1mo, 16.37±3.42mmHg at 3mo, and 18.32±2.14mmHg at 6mo postoperatively. All eyes had controlled IOP(<21mmHg)at last visit in which 3 eyes needed one kind of anti-glaucoma medication, and 2 eyes needed two kinds of anti-glaucoma medication. All eyes showed regression of NV in 3-8d, and recurrent NV was detected in one eye at 36d postoperatively. No serious complications occurred.

CONCLUSION:Combined surgery of intravitreal injection of ranibizumab as adjunctive treatment for PHACO+IOL+TRAB+PPV+EPC could be safe and effect for neovascular angle-closure glaucoma secondary to PDR.