Neovascular glaucoma following central retinal vein obstruction

The results of a prospective clinical and fluorescein angiographic study of 155 patients with central retinal vein obstruction (CRVO) were analyzed to identify risk factors contributing to the subsequent development of iris neovascularization (NVI) and neovascular glaucoma (NVG). Of 144 untreated eyes, 20% developed NVG. The eyes were classified as having either an ischemic or a hyperpermeable type of CRVO according to the extent of retinal capillary nonperfusion demonstrated by the initial fluorescein angiogram. The risk of developing NVG was found to be approximately 60% in those eyes with extensive retinal ischemia. None of the 22 eyes with an ischemic CRVO treated with panretinal photocoagulation (PRP) prior to the onset of NVI developed NVG.     

Efficacy of Panretinal Photocoagulation in Preventing Neovascular Glaucoma Following Ischemic Central Retinal Vein Obstruction

Ninety-three percent of eyes that develop neovascular glaucoma (NVG) following central retinal vein obstruction (CRVO) have an ischemic index greater than 50%. An ischemic index (percentage of retinal capillary nonperfusion) of 50% represents approximately 10 disc areas of retinal ischemia as determined by computer analysis of standard 30° fluorescein angiograms. The difficulties of following patients clinically and angiographically at frequent intervals over extended periods of time, and the tendency for iris neovascularization (NVI) to develop and to progress rapidly to NVG with painful loss of vision emphasizes the importance of early recognition and treatment of high-risk eyes. In this prospective study (1976–81), 100 consecutive eyes with an ischemic CRVO pattern (average ischemic index 82%) received early argon laser panretinal photocoagulation (PRP) and none developed NVG unless another ischemic event occurred following treatment. Prophylactic PRP in high-risk ischemic CRVO eyes appears to eliminate virtually the devastating complications of NVG.     

糖尿病视网膜病变玻璃体切除术后新生血管性青光眼原因分析

目的:探讨增殖性糖尿病视网膜病变患者玻璃体切除术后发生新生血管性青光眼的原因。方法:对行玻璃体切除术后9例病例(11眼)发生新生血管性青光眼的原因进行回顾性分析。结果:11眼中行晶状体手术7眼,其中后囊破裂或不完整6眼,术前存在虹膜新生血管(NVI)2眼,术后视网膜脱离1眼,手术后至发生新生血管性青光眼(NVG)期间11眼均未行眼底荧光血管造影和视网膜光凝。结论:术中联合行晶状体手术、玻璃体腔填充物、光凝效果、术后发生视网膜脱离、术前存在NVI等对术后发生新生血管性青光眼均有影响。     

虹膜荧光素血管造影在虹膜新生血管诊断中的应用

目的 探讨虹膜荧光素血管造影(IFA)在缺血性视网膜中央静脉阻塞(CRVO)虹膜新生血管(NVI)诊断中的价值.方法 经荧光素眼底血管造影(FFA)检查确诊的CRVO患者51例51只眼纳入研究.所有患者均行视力、裂隙灯显微镜检查、眼前节彩色照相、眼压及FFA+IFA检查.根据FFA检查结果分为非缺血性和缺血性CRVO,分别为20、31只眼.非缺血性CRVO20只眼中,男性11只眼,女性9只眼;年龄41～59岁.缺血性CRVO31只眼中,男性21只眼,女性10只眼;年龄28～62岁.采用德国海德堡眼底荧光血管造影仪进行FFA+IFA检查,将典型图像存入计算机图像处理系统进行分析.对比观察裂隙灯显微镜和IFA NVI的检出率.缺血性CRVO31只眼均行全视网膜激光光凝(PRP)治疗,其中,完成治疗27只眼,未坚持完成治疗4只眼.完成治疗后6个月,随访观察NVI消退情况.结果 非缺血性CRVO20只眼裂隙灯显微镜检查瞳孔缘及虹膜未见新生血管,占100.0%;IFA检查虹膜未见显影,呈色素遮蔽荧光,占100.0%.缺血性CRVO31只眼中,裂隙灯显微镜检查显示瞳孔缘及虹膜有细小新生血管13只眼,占41.9%;IFA检查显示NVI 23只眼,占74.2%.2种检查方法NVI检出率比较,差异有统计学意义(Z=-3.425,P=0.001).IFA检查NVI分别表现为小团状、细线状或不规则交叉网状强荧光染色及渗漏.完成PRP治疗的27只眼IFA检查结果显示,瞳孔缘及虹膜表面未见荧光染色及渗漏;未坚持完成PRP治疗4只眼,1～2个月后出现新生血管性青光眼(NVG).结论 IFA可以提示眼前节的缺血状态,具有较高的特异性,辅助CRVO缺血型早期诊断,预测是否发展NVG.

Abstract：

Objective To evaluate the application value of iris fluorescein angiography (IFA) in the diagnosis of ischemic center retinal vein occlusion (CRVO). Methods Fifty-one patients (51 eyes) with CRVO which had been diagnosed by fundus fluorescein angiography (FFA) were studied. All patients underwent the examination of visual acuity, slit lamp biomicroscope, anterior segment color photography,intraocular pressure, FFA and IFA. The patients were classified as non-ischemic CRVO (20 eyes) and ischemic CRVO (31 eyes). The 20 non-ischemic CRVO patients included 11 males and nine females, aged from 41 to 59 years. The 31 ischemic CRVO patients included 21 males and 10 females, aged from 28 to 62 years. FFA and IFA were performed for all the patients using Heidelberg retina angiograph, and the classic pictures were analyzed by the computer image processing system. The detection rate of iris neovascularization (NVI) by slit lamp biomicroscope and IFA was analyzed. All ischemic CRVO eyes underwent panretinal photocoagulation (PRP), and PRP was completed in 27 eyes and not completed in four eyes. Six months after PRP the regression of iris NVI was followed up. Results All non-ischemic CRVO eyes (100. 0% ) had no neovascularization on papillary margin and iris by slit lamp biomicroscopy, and had no fluorescence (pigment blocked fluorescence) on IFA. Thirteen eyes (41.9%) and 23 eyes (74.2%) of the 31 ischemic eyes had NVI by slit lamp biomicroscope and IFA, respectively. The NVI detection rate of those two methods was statistically different (Z= - 3. 425, P = 0. 001 ). NVI showed strong fluorescence and leakage with variable patterns (small blocks, thin lines and irregular cross-links) by IFA. There was no fluorescence staining and leakage on papillary margin and iris in 27 eyes who completed the PRP, but the neovascular glaucoma (NVG) occurred in one eyes who discontinued the PRP treatment after one to two months. Conclusions IFA has a high specificity in CRVO which hints the ischemic state of anterior segment. It is helpful to the early diagnosis of ischemic CRVO and the turnover of NVG.     

The development and management of neovascular glaucoma

Patients with neovascular glaucoma (NVG) often present with neovascularisation of the iris (NVI) already established and prompt energetic treatment of these patients is needed to reverse or stabilise the condition with possible retention of some visual function. In this series if the ocular media were still clear panretinal photocoagulation (PRP) caused regression of NVI in about 60% of cases and if a persistent rise in intraocular pressure (IOP) were still present this could be dealt with by drainage operation, Molteno implant or cyclophotocoagulation. If the media were already opaque or NVI did not regress then a Molteno implant or cyclophotocoagulation was used to reduce the IOP, preserving corneal endothelial function so that a comfortable eye could be obtained. Some regression of the NVI process was likely with time if the IOP were controlled by surgical treatment. Of 32 patients reviewed here, 20 patients developed NVG following a central retinal vein occlusion; in six patients NVG followed diabetic proliferative retinopathy, in five it followed arterial occlusion, and in one it followed an old traumatic retinal detachment. In those patients where NVG followed venous or arterial occlusion the common risk factors were always present. Patients were usually under treatment for their systemic condition but this treatment should be reviewed.     

Characteristics of the Hemispheric Retinal Vein Occlusion

Hemispheric retinal vein occlusions involve the venous return from approximately one-half of the retina and have characteristics of both central retinal vein occlusions and branch retinal vein occlusions. One hundred six such occlusions were studied in 104 patients whose average age was 66 years. The site of the hemispheric vein occlusion was located in a branch retinal vein in 90% of the eyes, and in 10% of the eyes it was located in one of the dual intraneural trunks of the central retinal vein. Of these eyes, 11 developed neovascularization of the disc, 9% developed neovascularization of the retina elsewhere, 9% developed neovascularization of the iris, and 3% developed neovascular glaucoma. Neovascularization was positively correlated with an increasing percentage of capillary nonperfusion (ischemic index) within the area of occlusion. Prophylactic argon laser treatment was effective in reducing the incidence of neovascularization in eyes with significant capillary nonperfusion.     

早期PRP与复方樟柳碱颞浅动脉旁穴位注射治疗RR的疗效

目的：观察早期视网膜激光光凝（PRP）联合复方樟柳碱颞浅动脉旁皮下注射治疗放射性视网膜病变（RR）的临床疗效。方法：在我院确诊为因鼻咽癌外照射后发生RR的患者21例41眼,早期行双眼视网膜激光光凝联合复方樟柳碱颞浅动脉旁穴位注射治疗,观察治疗后3mo最佳矫正视力（BCVA）、毛细血管无灌注区变化、视网膜新生血管及并发症情况。结果：治疗后观察3mo,视力提高6眼（14.6%）,视力不变31眼（75.7%）,下降4眼（9.7%）。2眼虹膜新生血管消退,1眼行睫状体光凝术;9眼（75%）视网膜新生血管消退;22眼（68.7%）原视网膜无灌注区消失,7眼（21.8%）原视网膜无灌注区（NPA）缩小〉5个DA,总有效率90.5%。1眼发生玻璃体出血,未见视盘及虹膜新生血管和新生血管性青光眼等并发症以及与治疗相关的并发症。结论：早期PRP与复方樟柳碱颞浅动脉旁穴位注射治疗是有效的、合理的中西医结合治疗方法。     

The development and management of neovascular glaucoma.

Patients with neovascular glaucoma (NVG) often present with neovascularisation of the iris (NVI) already established and prompt energetic treatment of these patients is needed to reverse or stabilise the condition with possible retention of some visual function. In this series if the ocular media were still clear panretinal photocoagulation (PRP) caused regression of NVI in about 60% of cases and if a persistent rise in intraocular pressure (IOP) were still present this could be dealt with by drainage operation, Molteno implant or cyclophotocoagulation. If the media were already opaque or NVI did not regress then a Molteno implant or cyclophotocoagulation was used to reduce the IOP, preserving corneal endothelial function so that a comfortable eye could be obtained. Some regression of the NVI process was likely with time if the IOP were controlled by surgical treatment. Of 32 patients reviewed here, 20 patients developed NVG following a central retinal vein occlusion; in six patients NVG followed diabetic proliferative retinopathy, in five it followed arterial occlusion, and in one it followed an old traumatic retinal detachment. In those patients where NVG followed venous or arterial occlusion the common risk factors were always present. Patients were usually under treatment for their systemic condition but this treatment should be reviewed.     

Role of anterior retinal cryoablation in the management of neovascular glaucoma

In a prospective study, the effect of anterior retinal cryoablation (ARC) in the management of neovascular glaucoma (NVG) was evaluated over two years, in 72 patients (74 eyes). The outcome of trabeculectomy/seton surgery preceded by 360° ARC was also analysed in 12 eyes of 12 patients (6 eyes in each group). Following ARC, pain relief with dramatic regression of anterior chamber inflammatory reaction was observed in 95% of the patients (59 eyes). At the end of the follow up, as confirmed by iris fluorescein angiography, regression of neovascularization of the iris was documented in 93.5% (58 eyes) of the cases. Intraocular pressure control (22 mm Hg) was achieved in 82.3% (51 eyes) cases. IOP control of 22 mm Hg was achieved in all the 6 eyes with the seton surgery following ARC. Similarly, control of IOP was successfully achieved in all the 6 eyes of patients with NVG with trabeculectomy with post operative course of 5-fluorouracil following ARC. ARC is strongly recommended in NVG, especially in eyes with media opacities and as a preliminary procedure for filtering surgery or drainage implant surgery.Abbreviations ARC Anterior retinal cryoablation - NVG Neovascular glaucoma - NVI Neovascularization of the iris     

早期全视网膜光凝与复方樟柳碱球后穴位注射治疗缺血性视网膜中央静脉阻塞的疗效

目的观察早期全视网膜光凝(panrentinal photocoagulation,PRP)联合复方樟柳碱球后穴位注射治疗缺血型视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)的临床疗效。方法在我院确诊为缺血型CRVO患者89例(89眼),早期行PRP和复方樟柳碱穴位注射治疗,观察治疗后3个月的视力、毛细血管灌注区变化、视网膜新生血管及并发症情况。结果治疗后观察3个月,视力提高25例(28.1%),不变56例(62.9%),下降8例(9.0%),总有效率91.0%。5例(5.6%)发生视网膜新生血管,73例(82.0%)原视网膜无灌注区消失,11例(12.4%)原视网膜无灌注区缩小>5个视盘面积,总有效率94.4%。并发黄斑囊样水肿79例,治疗后水肿减轻77例;黄斑出血10例,治疗后吸收8例。未见视盘及虹膜新生血管、玻璃体出血和新生血管性青光眼等并发症以及与治疗相关的并发症。结论早期PRP与复方樟柳碱球后穴位注射治疗缺血型CRVO是有效的、合理的中西医结合治疗方法。     

Comparison of healing patterns of different side-cut angulations after FS-LASIK

AIM: To investigate and evaluate healing patterns around flaps made with different side-cut angulations after femtosecond laser in situ keratomileusis(FS-LASIK).METHODS: Thirty-four patients(68 eyes) received a 90° side-cut(n=34) or a 120° side-cut flaps(n=34) made with a femtosecond laser. One day, 1 wk, 1 and 3 mo postoperatively, side-cut scar was evaluated under slit-lamp photography according to a new grading system(Grade 0=transparent scar, 1=faint healing opacity, and 2=evident healing opacity). In vivo corneal confocal microscopy and anterior segment optical coherence tomography(AS-OCT) were used to observe wound-healing patterns around flap margin in the two groups. Sirius Scheimpflug Analyzer was also used to analyze higher order aberrations 3 mo after surgery.RESULTS: There were no significant differences in flap wound-healing patterns at each follow up between the two groups(P>0.05). Three months after surgery, the flap edge scar classified as Grade 0 had excellent apposition and rapid nerve regeneration. At 3 mm and 5 mm pupil diameters, there were significant differences in trefoil aberrations between the two groups(P<0.05), but no statistically significant differences were found in total higher order aberrations(HOAs), spherical aberrations or coma in any of the pupil size conditions(P>0.05).CONCLUSION: Flap edge scars classified as Grade 0 have excellent apposition and rapid nerve regeneration, and 120° side-cut angle flaps induce less trefoil aberrations after FS-LASIK.     

Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade

AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation(PRP) or extra-PRP were conducted within 2 d. The follow-up time was 6 mo. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), neovascularization of iris(NVI) were recorded before and after treatment.RESULTS: Within 2 d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2 d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.     

The efficacy of panretinal photocoagulation for neovascularization of the iris after central retinal artery obstruction

Panretinal photocoagulation (PRP) is widely used for a variety of ischemic ocular conditions. In diseases that produce neovascularization of the iris (NVI), such as diabetes mellitus and central retinal vein obstruction, a judiciously timed PRP can reduce the incidence of neovascular glaucoma. Neovascularization of the iris can occur after central retinal artery obstruction (CRAO) as well. In this article, the authors report the outcome of 17 patients who received PRP to treat rubeosis iridis secondary to CRAO. Eleven of the 17 patients (65%) showed regression of NVI after PRP. Although the uncontrolled and retrospective nature of this study precludes drawing definitive conclusions from these data, PRP appears to be effective in reducing the incidence of neovascular glaucoma, if it is delivered before the development of elevated intraocular pressure (IOP). Once neovascular glaucoma occurs, additional modalities appear to be necessary in order to adequately control the elevated IOP.     

Pars plana vitrectomy and panretinal photocoagulation combined with trabeculectomy for successful treatment of neovascular glaucoma

Background Treatment of neovascular glaucoma (NVG) must be focused on the reduction of intraocular pressure (IOP) and prompt application of pan retinal photocoagulation (PRP). A combination of complete PRP during vitrectomy with trabeculectomy should theoretically be a better method to lower the IOP rapidly in eyes with NVG. The purpose of our study is to assess the efficacy of combining pars plana vitrectomy and PRP with trabeculectomy assisted by mitomycin C (MMC) on NVG eyes secondary to diabetic retinopathy.Methods Twenty-five eyes with NVG associated with diabetic retinopathy had pars plana vitrectomy, followed by PRP and trabeculectomy with MMC. The eyes were divided into two groups: nine eyes with vitreous hemorrhage, fibrovascular membrane and/or retinal detachment were placed in the Proliferation group; and 16 eyes without vitreous hemorrhage, fibrovascular membrane, or retinal detachment were placed in the PC (photocoagulation) group. These eyes had vitrectomy performed so that PRP could be safely performed from ora to ora. The surgical outcome in the two groups was assessed by Kaplan-Meier survival analysis. The criteria for success were a postoperative intraocular pressure (IOP) ≤21 mmHg and a preservation of light perception.Results In the Proliferation group, Kaplan-Meier life-table analysis showed that the success rate was 55.6% after 1 year and 18.5% after 2 years. The success rate in the PC group was 81.2% from 1 to 3 years after surgery. The surgical outcome was significantly better in the PC group than in the Proliferation group (P=0.009). In the Proliferation group, four eyes had preoperative vitreous hemorrhage, three eyes had a fibrovascular membrane, and two eyes had a retinal detachment. Three of four eyes with vitreous hemorrhage achieved good IOP control. On the other hand, the IOP of all eyes with retinal detachment and fibrovascular membrane were not lowered significantly.Conclusions Complete PRP combined with trabeculectomy with MMC can effectively reduce the elevated IOP in eyes with NVG. However, this combined treatment is not effective in eyes with proliferative membranes and retinal detachments.     

Retinal and disc neovascularization in Behçet's disease and efficacy of laser photocoagulation

Background: The vasoocclusive episodes resulting from Behçet's disease can cause capillary dropout and vascular remodeling. Retinal and disc neovascularizations, which occur as a result of occlusive vasculitis, can cause recurrent vitreal hemorrhages and neovascular glaucoma leading to severe visual impairment. Methods: 1080 eyes of 540 patients with Behçet's disease were examined between 1973 and 1993. Of the 912 eyes with posterior segment involvement, laser photocoagulation could be performed in 13 of 25 eyes with disc neovascularization (NVD), 12 of 22 eyes with retinal neovascularization (NVE), and 4 of 6 eyes with NVD and NVE. Laser was directed at areas of NVE and retinal capillary nonperfusion. In cases of NVD, panretinal photocoagulation was performed. Results: The rate of regression of NVD was significantly greater in laser-treated eyes than in the untreated group. The results were similar in cases of NVD with NVE. In eyes with NVE which underwent laser photocoagulation, the NVE regressed. None of the treated eyes developed neovascular glaucoma during the follow-up period. Vitreous hemorrhage occurred in two laser-treated eyes. Conclusion: Laser photocoagulation is successful in preventing complications of retinal and disc neovascularizations. Thus, in cases of occlusive vasculitis associated with Behçet's disease, laser photocoagulation should be considered for prevention of complications such as vitreous hemorrhage and neovascular glaucoma.Presented at the meeting of the Club Jules Gonin, Versaille, France, 8-13 September 1994     

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM: 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. CONCLUSION: 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.     

氩激光治疗视网膜静脉阻塞57例

目的:分析57例氩激光光凝治疗视网膜静脉阻塞(retinal vein occlusion, RVO)的临床疗效。方法:随访我院57例被确诊为视网膜静脉阻塞并经氩激光光凝治疗后的患者,观察患者的视力、眼底改变以及并发症情况并评价氩激光光凝治疗视网膜静脉阻塞的临床价值。激光治疗方法分为黄斑区格栅样光凝,局灶性视网膜光凝及全视网膜光凝。结果:经氩绿激光光凝治疗57例后3～6mo给予复查:末次随访视力提高23眼,视力无明显变化25眼,视力下降9眼;激光治疗后复查荧光素眼底血管造影 (观察视网膜毛细血管无灌注区面积变化及新生血管消退情况),治疗有效54眼, 3眼发展为新生血管性青光眼(NVG)。而激光光凝对于黄斑部晚期并发症无明显效果。结论:激光光凝治疗可提高中心视力,可促进视网膜水肿、出血、渗出的吸收,同时减少视网膜静脉阻塞引起的新生血管,对于预防并延缓增殖性玻璃体视网膜病变和继发性新生血管性青光眼的发生有明显效果。     

缺血型视网膜静脉阻塞出血多眼光凝探讨

目的 探討出血偏多的缺血型视网膜静脉阻塞光凝方法及其疗效。方法 采用Zeiss Lumenis NOVUS OMNI多波长激光仪,利用红光、大光斑、低能量、长时间对视网膜出血偏多的缺血型分支、半侧或中央静脉阻塞并黄斑水肿患者49人52只眼实施局部或全视网膜光凝。参数：黄斑区：0.1 ～0.3秒,光斑大小50～100 μm,能量100～200 mW,中心凹1000 μm外开始,Ⅰ级光斑反应;其余区域：0.3～0.7 s,200～500μm,150～300 mw,III级光斑轻-中强度反应,如光斑反应不足,则以增长时间为主,增加能量为辅;分2～4次完成,间隔2～3周。观察视网膜出血水肿消退及视力改变等情况,随访3～30个月。结果 (1)18只眼(34.62％)首次光凝2～3周后视网膜出血水肿明显消退,其中9只眼(17.31％)视力提高,8只眼(15.39％)视力不变,1只眼(1.92％)视力下降。激光后3个月FFA证实治疗有效。(2)31只眼(59.62％)首次光凝2～3周后视网膜出血水肿部分消退,全部光凝完成后3月,眼底出血水肿完全消退,FFA证实治疗有效。其中8只眼(15.38％)视力提高;20只眼(38.46％)视力保持不变;3只眼(5.77％)视力下降。(3)3只眼新生血管性青光眼患者,病情部分改善稳定。其余患者随访期内未新发生玻璃体出血及新生血管性青光眼。结论 对出血偏多的缺血型视网膜静脉阻塞,可选用红光,使用大光斑、低能量、长时间的光凝方法,获得足够数量和强度的有效光斑,促进视网膜出血水肿吸收,减少病情恶化可能。     

Ocular neovascularization with retinal vascular occlusion-III. Incidence of ocular neovascularization with retinal vein occlusion

A prospective natural history study was conducted in 721 eyes with various types of retinal vein occlusion (RVO) to determine the incidence of various types of ocular neovascularization (NV) and the factors that influence the development of ocular NV. The material was 360 eyes with central retinal vein occlusion (CRVO), 97 eyes with hemi-CRVO, and 264 eyes with branch retinal vein occlusion (BRVO); these cases were further subdivided into six groups for logical data analysis: nonischemic CRVO (venous stasis retinopathy-VSR, 282 eyes), ischemic CRVO (hemorrhagic retinopathy-HR, 78 eyes), hemi-VSR (66 eyes), hemi-HR (31 eyes), major BRVO (191 eyes) and macular BRVO (73 eyes). Ocular NV attributable to RVO was seen only in HR, hemi-HR, and major BRVO. In HR the anterior segment was the major site of NV, with iris and angle NV and neovascular glaucoma (NVG), while in hemi-HR and major BRVO the retina and optic disc were the major sites of NV. The principal factor influencing the development of ocular NV in RVO seems to be the severity and extent of retinal ischemia, while duration of follow-up since onset also plays an important role in determining the incidence of ocular NV. The findings and subject of ocular NV in RVO are discussed in detail along with a review of the pertinent literature.     

Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy,central retinal vein occlusion,and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure

Purpose:To evaluate the outcomes of trabeculectomy in the eyes with neovascular glaucoma (NVG), caused by proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO), and ocular ischemic syndrome (OIS).Methods:A retrospective review of NVG eyes that underwent trabeculectomy between 1991 and 2019. Complete success was defined as intraocular pressure (IOP) between 6 and 21 mmHg without antiglaucoma medications (AGM). The risk factors were analyzed by Cox''s proportional hazard model.Results:The study included 100 eyes of 100 subjects with a mean age of 58 ± 9.8 years and a median follow-up of 1.27 years (interquartile range: 0.63, 2.27). The cause of NVG was PDR in 59 eyes (59%), CRVO in 25 eyes (25%), and OIS in 16 eyes (16%). Trabeculectomy with mitomycin-C was performed in 88 eyes and trabeculectomy in 12 eyes. The cumulative complete success probability of trabeculectomy in PDR was 50% (95% confidence interval [CI]: 38, 65) at 1 year, 8% (1, 46) at 3–5 years. In OIS, it was 64% (43, 96) from 1 to 5 years. In CRVO, it was 75% (59, 94) at 1 year, 45% (23, 86) from 2 to 5 years. The PDR was associated with a higher risk of surgical failure compared to OIS (P = 0.04) and CRVO (P = 0.004). Other significant risk factors were increasing age (P = 0.02), persistent neovascularization of iris (NVI) (P = 0.03), higher number of anti-vascular endothelial growth factor (VEGF) injections prior to trabeculectomy (P = 0.02), and delay in performing trabeculectomy (P = 0.02).Conclusion:Compared to CRVO and OIS, the eyes with NVG secondary to PDR had poor success with trabeculectomy. Older age, persistent NVI, need for a higher number of anti-VEGF injections, and delayed surgery were associated with a higher risk for trabeculectomy failure.