Intravitreal Ranibizumab injection combined with trabeculectomy and PRP for neovascular glaucoma

Abstract

AIM: To determine the medium term efficacy of intravitreal ranibizumab injection combined with subsequent trabeculectomy and panretinal photocoagulation(PRP)for the treatment of neovascular glaucoma(NVG). METHODS: In this retrospective study, 21 neovascular glaucoma patients(21 eyes)were enrolled between January 2015 and March 2017 in the department. All cases received combination therapy with intravitreal injection(IVR)of ranibizumab, subsequent 5-fluorouracil(5-FU)padding trabeculectomy and then pan-retinal photocoagulation(PRP). Intraocular pressure(IOP), visual function, the status of neovascularization of the iris and the anterior chamber angle, the use of anti-glaucoma medications and the surgical complication were recorded during the complete follow-up period of 6mo before and after treatment. RESULTS: Of the 21 patients, all completed the 6-month follow-up, and 3 completed the 2a follow-up(mean 7.8mo). The IOP of all 21 eyes were well controlled after the combination therapy. The post-operative IOP in the 6mo after treatment was 18.50±3.51mmHg, which was significantly lower compared with the pre-operative IOP(53.17±10.52mmHg, P=0.001). Visual acuity improved after treatment, to some extent. Anterior chamber hemorrhage and vitreous hemorrhage occurred in three surgical eyes, which were absorbed after conservative treatment. Neovascularization of the iris and angle had clearly regressed in all of the patients after completion of the treatment process. CONCLUSION: The medium outcomes reveals that intravitreal ranibizumab injection combined with subsequent 5-fluorouracil padding trabeculectomy and PRP is a possible new method for NVG.

Keywords

• ranibizumab
• neovascular glaucoma
• trabeculectomy
• panretinal photocoagulation
• 5-fluorouracil