Efficacy of Intravitreal Ranibizumab Combined With Ahmed Glaucoma Valve Implantation for the Treatment of Neovascular Glaucoma

Min Tang; Yang Fu; Ying Wang; Zhi Zheng; Ying Fan; Xiaodong Sun; Xun Xu

Disclosures

BMC Ophthalmol. 2016;16(7) 

In This Article

Results

A total of 43 patients (43 eyes) were enrolled. The patients were divided into the injection group (n = 21), who received AGV implantation three to 14 days (average 8.6 ± 2.2 days) subsequent to IVR, and the control group (n = 22), who received AGV implantation alone. The baseline information of the two groups is presented in Table 1. There were no significant differences in baseline measures between the two groups.

Of the 43 patients, 40 completed the 6-month follow-up and 37 completed the 1-year follow-up. In particular, in the injection group two patients received intraocular surgery (at three months and six months) and one patient was lost to follow up (at 12 months). In the control group two patients received intraocular surgery (at six months and 12 months) and one patient were lost to follow up (at 12 months). The dropout rates were not significantly different between the two groups (six months: P = 0.52; 12 months: P = 0.95).

The mean IOPs at various time points throughout follow-up decreased significantly from baseline in both groups (ANOVA, α = 0.05). IOP rose gradually in both groups with the passage of time. IOPs at various time points throughout follow-up were not significantly different between the two groups (Table 2). The success rates declined gradually in both groups with the passage of time. Success rates at various time points throughout follow-up (Table 3) were not significantly different between the two groups (P = 0.84, Fig. 1).

Figure 1.

Success rates in both groups. Note: Difference in success rate throughout follow-up was compared between the two groups using the Log-Rank test (P = 0.84)

The two groups showed different patterns of BCVA changes after surgery. In the injection group, BCVA improved significantly and peaked for one to three months before declining sharply to levels comparable to that of the control group. In the control group, BCVA increased slightly, peaked at one month, and then gradually declined. Inter-group statistical analysis showed significant differences only at three-month follow-up (Table 4). BCVAs in both groups fell back to the baseline at six months or 12 months.

The number of anti-glaucoma medications used at various time points throughout follow-up in both groups declined significantly from baseline (ANOVA, α = 0.05). And the number of medications increased gradually in both groups with the passage of time. There was no significant difference at various time points between the two groups (Table 5).

Of the 21 patients in the injection group, anterior uveitis developed in seven patients one day after surgery, but was resolved with topical steroid drops within two weeks; proliferative membrane formed in the pupil in one patient and was removed using YAG laser. Nine patients experienced mild hyphema, which resolved itself within two weeks. Two patients developed mild vitreous hemorrhage, which resolved itself within a month. Two patients experienced transient ocular hypertension (> = 30 mm Hg) and mild corneal edema one day after surgery due to excessive viscoelastic residues, which were alleviated after eyeball massage. Blood clots developed in the drainage tube in three patients, but resolved themselves in two and were cured by YAG laser at day 3 after surgery. The lens of the eye turned cloudy rapidly in one patient within days after surgery, who underwent cataract surgery two months after surgery and withdrew from this study. Of the 23 patients in the control group, 10 patients developed postoperative anterior uveitis, which was revolved within two weeks after topical steroid drops. Nine patients experienced mild hyphema, which resolved itself within two weeks. Five patients developed mild vitreous hemorrhage, which resolved itself within a month. Four patients experienced transient ocular hypertension (including two combined with corneal edema), which were alleviated after eyeball massage. Blood clots developed in the drainage tube in four patients, but resolved themselves. One patient developed conjunctival retraction at three months which did not cause drainage tube exposure and therefore was left unattended. Mild choroidal hemorrhage in local areas developed in one patient one day after surgery as revealed by B ultrasonography (less than 90°) and resolved itself gradually within two months. No serious complications such as malignant glaucoma, sustained low IOP, endophthalmitis, lose of light perception, and retinal detachment occurred in either of the two groups (Table 6).

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