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Abstract #15473 Published in IGR 1-3
Pars plana vitrectomy, endolaser coagulation of the retina and the ciliary body combined with silicone oil endotamponade in the treatment of uncontrolled neovascular glaucoma
Bartz-Schmidt KU; Thumann G; Psichias A; Krieglstein GK; Heimann KGraefe's Archive for Clinical and Experimental Ophthalmology 1999; 237: 969-975
PURPOSE: Neovascular glaucoma develops on a background of ischemic ocular pathologies, such as diabetic eye diseases or central retinal vein occlusion. Development of neovascular membranes in the chamber angle leads to elevated intraocular pressure (IOP). Since cyclodestructive therapy or drainage surgery often fails, the authors have examined intense antiproliferative surgery as a treatment for advanced neovascular glaucoma. PATIENTS AND METHODS: Thirty-two patients with uncontrolled neovascular glaucoma (mean IOP, 45.5 mmHg) subsequent to central retinal vein occlusion or advanced diabetic retinopathy, underwent antiproliferative surgery, which comprised pars plana vitrectomy, panretinal laser treatment and direct laser coagulation of the ciliary processes, followed by silicone oil tamponade. Patients were followed up for a minimum of one year and for as long as three years. RESULTS: One week following surgery, the IOP was normal, ranging from 8-21 mmHg, in 52% of eyes (15/29). After three months, the IOP was normal in 50% (16/32); after six months, in 59% (16/27); and after one year, in 72% (18/25). Of the ten eyes that lost all sight after the surgery, seven had a history of central retinal vein occlusion. Hypotony was observed in 6% of eyes (2/32) three months after surgery; after six months, hypotony was present in 15% (4/27), and after one year in 12% (3/25). CONCLUSIONS: The theoretical premise of this surgical intervention (antiproliferative surgery_ is that laser treatment interrupts the self-enhancing pathway of retinal ischemia, release of proliferative factors and increase in IOP. The silicone oil endotamponade prevents postoperative complications and supports the rapid regression of rubeosis iridis by separating the anterior from the posterior segment.
Dr. K.U. Bartz-Schmidt, Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Joseph-Stelzmann-Strasse 9, D-50931 Cologne; Germany
Classification:
9.4.5.1 Neovascular glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous)
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
12.16 Vitrectomy (Part of: 12 Surgical treatment)
