Analysis of secondary surgery for neovascular glaucoma after vitrectomy in PDR

Abstract

AIM:To investigate risk factors and efficacy of reoperation for neovascular glaucoma(NVG)secondary to vitrectomy in proliferative diabetic retinopathy(PDR). METHODS:Seven cases(7 eyes)from October, 2009 to December, 2012 were analyzed retrospectively. All the patients had NVG after the primary vitrectomy for PDR and were performed secondary vitrectomy combined with laser photocoagulation. RESULTS: The mean intraocular pressure(IOP)was(11.21±4.22)mmHg before primary surgery. The number of laser spots ranged from 622 to 1 124 during the first vitrectomy. Cataract extraction was performed in all 7 cases and intraocular lens was implanted in 5 cases. The mean IOP was(10.11±3.62)mmHg during 2mo after the primary surgery. During follow-up, all the patients had significantly progressive intraocular inflammation. Vitreous hemorrhage was not absorbed completely in 2 cases and recurrent vitreous hemorrhage occurred in the other 5 cases. Five cases had poor glycemic control and the other 2 cases had bad blood pressure control. NVG occurred in all 7cases. The mean IOP was(41.13±7.76)mmHg before the secondary surgery. After the secondary surgery, the IOP were under control in 5 cases. For the other 2 cases, the IOP was controlled in one case by transscleral cyclophotocoagulation, another one was lost in follow-up with uncontrolled IOP.CONCLUSION: Primary vitrectomy combined with lens extraction, insufficient laser speckle, unabsorbed and recurrent vitreous hemorrhage, intraocular inflammation and systemic condition may be the risk factors associated with the occurrent of NVG after vitrectomy in PDR. Secondary vitrectomy combined with sufficient retinal photocoagulation is efficiency for NVG after vitrectomy for the PDR.

Keywords

• diabetic retinopathy
• vitrectomy
• neovascular glaucoma
• secondary surgery