THE ROLE OF ANTI-VEGF THERAPY IN IMPROVING THE EFFICACY OF SURGICAL TREATMENT OF SECONDARY NEOVASCULAR GLAUCOMA
Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic diseases. Aim. To investigate the fluctuation of vascular endothelial growth factor concentration after intravitreal ranibizumab injections and to evaluate the effect of anti-VEGF therapy on the outcome of surgical...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Danylo Halytsky Lviv National Medical University
2024-10-01
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| Series: | Acta Medica Leopoliensia |
| Subjects: | |
| Online Access: | https://amljournal.com/index.php/journal/article/view/397 |
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| Summary: | Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic diseases.
Aim. To investigate the fluctuation of vascular endothelial growth factor concentration after intravitreal ranibizumab injections and to evaluate the effect of anti-VEGF therapy on the outcome of surgical treatment of NVG.
Materials and Methods. The study included 25 patients (25 eyes) with NVG who underwent surgery due to IOP non-compensation (more than 26 mm Hg) on maximal hypotensive therapy. In 21 cases the cause of IOP was proliferative diabetic retinopathy (PDR), in 4 cases it was central retinal vein occlusion (CRVO) or its branches. The control group consisted of 20 patients (20 eyes) with PDR, but without NVG. Patients underwent trabeculectomy (TE) according to our modification in 18 cases or implantation of the Ex-PRESS mini-shunt in 7 cases. Lucentis was injected intravitreally at a dose of 0.5 mg 5-7 days before surgery. Aqueous humour samples were taken during surgery to determine the concentration of VEGF.
Results and Discussion.. All patients showed a reduction of neovascularisation 3-5 days after ranibizumab injections. Pre-treatment intraocular pressure was 30.2±5.8 mm Hg in all patients and 17.3±3.8 mm Hg after 7 days. The number of antiglaucoma medications before and after surgery decreased by 66.7%. Mean visual acuity before surgery was 0.94±0.48 LogMar and 0.88±0.56 LogMar after surgery. Before treatment, the concentration of VEGF in the anterior chamber fluid ranged from 336.61±270.33 pg/ml to 47.86±12.27 pg/ml - 5-7 days after injection. In the control group, it averaged 54.78±18.56 pg/ml on days 5-7 after injection.
Conclusions. Anti-VEGF therapy and filtering surgery can reduce IOP by 47.2%, achieve IOP compensation in 96.8% of cases, reduce the number of antiglaucoma medications by 66.7% and prevent a significant decrease in visual acuity in 88.2% of cases. |
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| ISSN: | 1029-4244 2415-3303 |