Tube-shunt surgery versus neodymium:YAG cyclophotocoagulation in the management of neovascular glaucoma.
OBJECTIVE
To determine the relative effectiveness of neodymium:YAG (Nd:YAG) cyclophotocoagulation (CPC) and tube-shunt surgery on intraocular pressure (IOP) control in eyes with neovascular glaucoma (NVG).


METHODS
Retrospective, case-by-case matched, comparative group study.


METHODS
Twenty-four patients with NVG treated with noncontact Nd:YAG-CPC were matched with 24 patients who underwent tube-shunt surgery. Matching criteria included the underlying disorder causing angle neovascularization, the lens status, and patient's age.


METHODS
Tube-shunt surgery or Nd:YAG-CPC.


METHODS
Postoperative IOP (IOP > or = 6 and < or = 25 mmHg), visual acuity, and presence of any postoperative complications.


RESULTS
Satisfactory IOP control (IOP < or = 25 mmHg and > or = 6 mmHg) was achieved in 9 eyes (37.5%) treated with Nd:YAG-CPC compared with 16 eyes (66.7%) receiving a tube-shunt procedure (P = 0.04) over a mean follow-up of 16.9 +/- 14.6 and 15.2 +/- 11.8 months, respectively. In the matched pairs in both groups that had nonequivalent outcomes, the proportions with persistently high IOP or hypotony were both greater in the CPC group than in the tube-shunt group. The cumulative proportion of failure in the CPC group was 20.8% at 6 months, 35.4% at 1 year, and 71.2% at 3 years postoperatively. In the tube-shunt group, the cumulative proportions of failure at 6 months and 1 year were close to those in the CPC group (12.5% and 29.2%, respectively), but lower 3 years after surgery (43.3%). Eleven eyes (45.8%) in the CPC group lost light perception versus four eyes (16.7%) in the tube-shunt group. Complication rate was higher in the tube-shunt group.


CONCLUSIONS
This study suggests that, in the management of NVG, tube-shunt surgery more frequently controls IOP in a satisfactory range, with less hypotony and less visual loss, than noncontact Nd:YAG-CPC.
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T E
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William and Anna Goldberg Glaucoma Service, Wills Eye Hospital/Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
Katz
L J
LJ
Spaeth
G L
GL
Augsburger
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002924:Ciliary Body / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D018465:Molteno Implants; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity