Clinical Profile and Treatment Outcomes of Patients with Neovascular Glaucoma in a Tertiary Hospital in the Philippines
Angela Therese Y. Uy, MD, John Mark S. de Leon, MD, Jubaida M. Aquino, MD
Department of Health Eye Center, East Avenue Medical Center, Quezon City
Correspondence: Angela Therese Y. Uy, MD
Unit 38C Tower 2 Robinsons Place Residences, Padre Faura, Ermita Manila, 1000
e-mail: angela.therese.uy@gmail.com
Disclaimer: The authors report no conflicts of interest.
ABSTRACT
Objective: To report the clinical profile and treatment outcomes of neovascular glaucoma (NVG).
Methods: A retrospective cohort study was done in a single tertiary hospital. Medical records of patients diagnosed with NVG from January 2000 to August 2018 were reviewed and pertinent data were collected. Study outcomes included visual acuity (VA) and intraocular pressure (IOP) and were analyzed for eyes that received any of the following: intravitreal bevacizumab (IVBe), pan-retinal photocoagulation (PRP), trabeculectomy with mitomycin (trab-MMC), or diode laser cyclophotocoagulation (DLCP) with at least 1 month of follow-up.
Results: There were 162 patients (181 eyes) diagnosed with NVG. Mean age at the time of diagnosis was 55.6 ± 14 years. Diabetic retinopathy (DR) was observed in 81 (45%) eyes and central retinal vein occlusion (CRVO) in 48 (27%) eyes. Baseline VA was hand movement in 67 (37%) eyes and no light perception (NLP) in 49 (27%) eyes. Only 60 (33%) eyes had ≥1 month of follow up (mean of 73 ± 119.1 weeks) after procedures were done. IVBe was done in 22 (37%) eyes, trab-MMC in 20 (33%), PRP in 22 (37%), and DLCP in 24 (40%) eyes. IOP decreased from 45 to 20 mmHg (p<0.001) but VA decreased from LogMAR 1.7 to 2.1 (p<0.01). There was significant VA decrease in eyes that underwent a single procedure (p<0.02) but none in eyes that underwent 2 or 3 procedures. Nonetheless, there was significant IOP decrease (p<0.05) when one procedure was done. Of the 49 eyes that had baseline sight, 19 (41%) converted to NLP (p<0.01).
Conclusion: Most patients presenting with advanced NVG had DR and CRVO. Procedures led to better IOP but not VA and some lost vision. Aggressive screening for NVG among high-risk groups is warranted to institute treatment early.
Keywords: bevacizumab, central retinal vein occlusion, diabetic retinopathy, neovascular glaucoma, trabeculectomy
Philipp J Ophthalmol 2021;46: 82-87