title: Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of intravitreal ranibizumab (IVR) with panretinal photocoagulation (PRP) followed by trabeculectomy compared with Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG).
  
  
  METHODS
  This was a retrospective comparative study. We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included: diabetic retinopathy (25 eyes), and retinal vein occlusion (20 eyes). All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities (BCVA) were converted to the logarithms of the minimum angle of resolution (logMAR) for the statisitical analyses. Intraocular pressure (IOP), the logMAR BCVA and surgical complications were evaluated before and after surgery. The follow-up period was 12mo.
  
  
  RESULTS
  A total of 39 cases showed complete regression of iris neovascularization at 7d after injection, and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12mo after trabeculectomy and AGV implantation, respectively. In the trabeculectomy group, the logMAR BCVA improved at the last follow-up in 14 eyes, remained stable in 6 eyes and decreased in 2 eyes. In 4 cases, slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group, the logMAR BCVA improved in 14 eyes, remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases, and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery (F=545.468,P<0.05), and the mean postoperative logMAR BCVA was also significantly improved (F=10.964,P<0.05) with no significant difference between two groups.
  
  
  CONCLUSIONS
  It is safe and effective to treat NVG with this combined procedure, and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.
authors.affiliation: Qingdao University, Qingdao 266000, Shandong Province, China; Department of Ophthalmology, Qingdao Economic and Technological Development Area First People's Hospital, Qingdao 266555, Shandong Province, China.
authors.forename: Jin-Tao
authors.initials: JT
authors.lastname: Sun
authors.affiliation: Department of Ophthalmology, Laixi People's Hospital, Qingdao 266600, Shandong Province, China.
authors.forename: Hai-Jing
authors.initials: HJ
authors.lastname: Liang
authors.affiliation: Department of Ophthalmology, Qingdao Traditional Chinese Medical Hospital of Huangdao District, Qingdao 266500, Shandong Province, China.
authors.forename: Meng
authors.initials: M
authors.lastname: An
authors.affiliation: Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China.
authors.forename: Da-Bo
authors.initials: DB
authors.lastname: Wang
keywords: Ahmed drainage valve implantation; neovascular glaucoma; panretinal photocoagulation; ranibizumab; trabeculectomy