Full preoperative panretinal photocoagulation improves the outcome of trabeculectomy with mitomycin C for neovascular glaucoma.
OBJECTIVE
To investigate the efficacy of full panretinal photocoagulation (PRP) followed by trabeculectomy with mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG).


METHODS
This study is based on 30 consecutive eyes of 27 patients with NVG who underwent full PRP followed by trabeculectomy with MMC. NVG was secondary to proliferative diabetic retinopathy (23 eyes) and central retinal vein occlusion (7 eyes). Kaplan-Meier survival analysis of the surgical outcome was performed. Operative success was defined as an intraocular pressure (IOP) of < or = 21 mmHg without medical therapy.


RESULTS
Kaplan-Meier cumulative success rates at the 6-, 12-, and 24-month intervals were 86.5%, 74.7%, and 57.6%, respectively. Pseudophakia was the only identified significant risk factor for failure (p=0.0138; Fisher exact test). Additional surgical procedures were performed in 8 (26.6%) eyes. The mean IOP decreased from 41.0+/-10.2 mmHg to 18.2+/-9.2 mmHg (p<0.001; Wilcoxon signed rank test). The number of anti-glaucoma medications was reduced from 3.1+/-0.5 preoperatively to 0.3+/-0.7 postoperatively (p<0.001; Wilcoxon signedrank test). Twenty-four (80%) eyes were classified as surgical success after a mean followup period of 17.3+/-22.1 months. Twenty-two (73.3%) eyes had improved vision or retained preoperative vision.


CONCLUSIONS
Full PRP followed by trabeculectomy with MMC can effectively reduce the elevatedIOP associated with NVG. Presence of pseudophakia is a significant negative predictor of surgical outcome.
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh - Saudi Arabia. abuasrar@ksu.edu.sa
S A
SA
Al Obeidan
E A
EA
Osman
S A
SA
Al-Amro
D
D
Kangave
A M
AM
Abu El-Asrar
D000328:Adult; D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D015355:Glaucoma, Neovascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011446:Prospective Studies; D012160:Retina / Q000601:surgery*; D012170:Retinal Vein Occlusion / Q000150:complications; D012307:Risk Factors; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D000477:Alkylating Agents; D016685:Mitomycin