Journal List > J Korean Ophthalmol Soc > v.56(8) > 1010053

Myeong In, Kim, Lee, and Park: Prognostic Factors for Neovascular Glaucoma after Vitrectomy in Eyes with Proliferative Diabetic Retinopathy

Abstract

Purpose

To investigate the prognostic factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy.

Methods

In the present study we retrospectively reviewed intraindividual and interocular differences in 14 patients (28 eyes) who underwent pars plana vitrectomy for proliferative retinopathy with vitreous hemorrhage and having only 1 eye neovascular glaucoma. The patients underwent vitrectomy between March 2008 and July 2014 at Maryknoll Hospital. The patient clinical da-ta on preoperative, intraoperative and postoperative factors were compared. Statistical analysis was performed using the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test and chi-square test to evaluate the significance of differences within the patient groups.

Results

The decrease of photopic b-wave amplitudes on the preoperative electroretinogram significantly correlated with the de-velopment of neovascular glaucoma after vitrectomy for proliferative retinopathy with vitreous hemorrhage ( p > 0.05).

Conclusions

Based on the results from the present study, decreased photopic b-wave amplitudes on preoperative electroretino-gram is an effective prognostic factor for the development of neovascular glaucoma after vitrectomy for proliferative retinopathy with vitreous hemorrhage.

References

1. Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75:813–20.
2. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision Clinical application of results of a random-ized trial-Diabetic Retinopathy Vitrectomy Study Report 4. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalo- mology. 1988; 95:1321–34.
3. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision Results of a randomized trial-Diabetic Retinopathy Vitrectomy Study Report 3. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalomology. 1988; 95:1307–20.
4. Aaberg TM, van Horn DL. Late complication of pars plana vitre-ous surgery. Ophthalmology. 1978; 85:126–40.
5. John T, Sassani JW, Eagle RC Jr. The myofibroblastic component of rubeosis iridis. Ophthalmology. 1983; 90:721–8.
crossref
6. Gartner S, Taffet S, Friedman AH. The association of rubeosis iri-dis with endothelialization of the anterior chamber: report of a clin-ical case with histopathological review of 16 additional cases. Br J Ophthalmol. 1977; 61:267–71.
7. Sivak-Callcott JA, O'Day DM, Gass JD, Tsai JC. Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology. 2001; 108:1767–76. quiz1777, 1800.
8. Helbig H, Kellner U, Bornfeld N, Foerster MH. Rubeosis iridis af-ter vitrectomy for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 1998; 236:730–3.
crossref
9. Wand M, Dueker DK, Aiello LM, Grant WM. Effects of panretinal photocoagulation on rubeosis iridis, angle neovascularization, and neovascular glaucoma. Am J Ophthalmol. 1978; 86:332–9.
crossref
10. Horsley MB, Kahook MY. Anti-VEGF therapy for glaucoma. Cur Opin Ophthalmol. 2010; 21:112–7.
crossref
11. Weiss DI, Shaffer RN, Nehrenberg TR. Neovascular glaucoma complicating carotid-cavernous fistula. Arch Ophthalmol. 1963; 69:304–7.
crossref
12. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329:977–86.
13. Blankenship GW. Management of vitreous cavity hemorrhage fol-lowing pars plana vitrectomy for diabetic retinopathy. Ophthal- mology. 1986; 93:39–44.
crossref
14. Blankenship G. Preoperative iris rubeosis and diabetic vitrectomy results. Ophthalmology. 1980; 87:176–82.
crossref
15. Aiello LM, Wand M, Liang G. Neovascular glaucoma and vitreous hemorrhage after cataract surgery in patients with diabetes mellitus. Ophthalmology. 1983; 90:814–20.
16. Weinreb RN, Wasserstorm JP, Parker W. Neovascular glaucoma following neodymium-YAG laser posterior capsulotomy. Arch Ophthalmol. 1986; 104:730–1.
crossref
17. Tanaka S, Ideta H, Yonemoto J. . Neovascularization of the iris in rhegmatogeneous retinal detachment. Am J Ophthalmol. 1991; 112:632–4.
18. Michels RG. Vitrectomy for complication of diabetic traction reti-nal detachment. Arch Ophthalmol. 1978; 88:237–46.
19. Kim YH, Suh Y, Yoo JS. Serum factors associated with neo-vascular glaucoma following vitrectomy for proliferative diabetic retinopathy. Korean J Ophthalmol. 2001; 15:81–6.
crossref
20. Hu DN, Ritch R, Liebmann J. . Vascular endothelial growth factor is increased in aqueous humor of glaucomatous eyes. J Glaucoma. 2002; 11:406–10.
crossref
21. Tripathi RC, Li J, Tripathi BJ. . Increased level of vascular en-dothelial growth factor in aqueous humor of patients with neo-vascular glaucoma. Ophthalmology. 1998; 105:232–7.
crossref
22. Sawada O, Miyake T, Kakinoki M. . Negative correlation be-tween aqueous vascular endothelial growth factor levels and axial length. Jpn J Ophthalmol. 2011; 55:401–4.
crossref
23. Man RE, Lamoureux EL, Taouk Y. . Axial length, retinal func-tion, and oxygen consumption: a potential mechanism for a lower risk of diabetic retinopathy in longer eyes. Invest Ophthalmol Vis Sci. 2013; 54:7691–8.
crossref
24. Yonemura D, Tsuzuki K, Aoki T. Clinical importance of the oscil-latory potential in the human ERG. Acta Ophthamol Suppl. 1962; Suppl 70. 115–23.
crossref
25. Li X, Sun X, Hu Y. . Electroretinographic oscillatory potentials in diabetic retinopathy. An analysis in the domains of time and frequency. Doc Ophthalmol. 1992; 81:173–9.
26. Satoh S, Iijima H, Imai M. . Photopic electroretinogram im-plicit time in diabetic retinopathy. Jpn J Ophthalmol. 1994; 38:178–84.
27. Algvere P, Gjӧ tterberg M. The diagnostic value of the oscillatory potentials of the ERG and fluorescein angiography in diabetic pro-liferative retinopathy. Ophthalmologica. 1974; 168:97–108.
crossref
28. Tzekov R, Arden GB. The electroretinogram in diabetic retinopathy. Surv Ophthalmol. 1999; 44:53–60.
crossref
29. Bresnick GH, Palta M. Predicting progression to severe pro-liferative diabetic retinopathy. Arch Ophthalmol. 1987; 105:810–4.
crossref
30. Ramsay WJ, Ramsay RC, Purple RL, Knobloch WH. Involutional diabetic retinopathy. Am J Ophthalmol. 1977; 84:851–8.
crossref
31. Tahara K, Matsuura T, Otori T. Diagnostic evaluation of diabetic retinopathy by 30-Hz flicker electroretinography. Jpn J Ophthamol. 1993; 37:204–10.
32. Bresnick GH, Palta M. Temporal aspects of the electroretinogram in diabetic retinopathy. Arch Ophthalomol. 1987; 105:660–4.
crossref
33. Hirose T. Evaluation of retinal function in the presence of vitreous opacities. Mackenzie FH, Tatsuo H, Charles LS, Retina Foundation, Boston , editors. Vitreous surgery and advances in fundus diagnosis and treatment. 1st. New York: Appleton-Centry -Crofts;1977. p. 79–97.
34. Hiraiwa T, Horio N, Takashi H. . Preoperative electroretino-gram and postoperative visual outcome in patients with diabetic vitreous hemorrhage. Jpn J Ophthalmol. 2003; 47:307–11.
35. Summanen P. Vitrectomy for diabetic eye disease. The prognositic value of pro-operative electroretinography and visual evoked cort-ical potentials. Ophthalmologica. 1989; 199:60–71.
36. Galloway NR. Electrophysiological testing of eyes with opaque media. Eye (Lond). 1988; 2:615–24.
crossref
37. Fuller DG, Knighton RW, Machemer R. Bright -flash electro-retinography for the evaluation of eyes with opaque vitreous. Am J ophthalmol. 1975; 80:214–23.
38. Algvere P, Persson HE, Wanger P. Preoperative electroretinograms and visual evoked cortical potentials for predicting outcome of vi-trectomy in diabetics. Retina. 1985; 5:179:83.
crossref

Table 1.
Demographic characteristics
Characteristics Value
Sex (n, %)
 Man 11 (79)
 Woman 3 (21)
Age (years)
 Mean ± SD 48.8 ± 11.7
 Range 27-69
Hypertension (n, %) 6 (43)
Hypercholesterolemia (n, %) 3 (21)
Nephropathy (n, %) 5 (36)
Vitreous hemorrhage (n, %) 14 (100)
Tractional membrane (n, %) 1 (7)
Epiretinal membrane (n, %) 2 (14)

Values are presented as mean ± SD unless otherwise indicated.

Table 2.
Comparison of preoperative factors between NVG group and non-NVG group
NVG group Non-NVG group p-value
Preop BCVA (log MAR) -1.12 ± 0.557 -0.84 ± 0.538 0.139
Preop IOP (mm Hg) 14.5 ± 2.66 14.9 ± 2.47 0.953
Preop lens status (n, %)
 Phakic 13 (92.9) 13 (92.9) 1.000
 Pseudophakic 1 (7.1) 1 (7.1) 1.000
Axial length 24.0 ± 0.71 23.9 ± 0.61 0.638
Preoperative panretinal photocoagulation (n, %) 8 (57.1) 8 (57.1) 1.000
Preoperative intravitreal bevacizumab injection (n, %) 5 (35.7) 5 (35.7) 1.000
Preoperative intravitreal triamcinolone injection (n, %) 3 (21.4) 1 (7.1) 0.470

Values are presented as mean ± SD unless otherwise indicated.

NVG = neovascular glaucoma; Preop = preoperation; BCVA = best corrected visual acuity; MAR = minimum angle of resolution; IOP = intraocular pressure.

p < 0.05;

Wilcoxon paired signed rank test;

Chi-square test.

Table 3.
Comparison of intraoperative and postoperative factors
NVG group Non-NVG group p-value,
Lens status
 Pre-PPV pseudophakia 1 (7.1) 1 (7.1) 1.000
 PPV + cataract operation 13 (92.9) 13 (92.9) 1.000
 Post-PPV cataract operation 0 0 1.000
 Phakia 0 0 1.000
Intraop intravitreal Avastin inj. 5 (35.7) 5 (35.7)
Silicone oil tamponade 2 (14.2) 2 (14.2) 1.000
Gas tamponade 1 (7.1) 1 (7.1) 1.000
Intraop PRP 14 (100) 14 (100) 1.000
PCCC 0 0 1.000
Posterior lens capsulotomy 0 0 1.000
Postoperative retinal detachment 0 0 1.000
Postop vitreous hemorrhage 4 (28.6) 2 (14.2) 0.353
Reoperation 4 (28.6) 3 (21.4) 0.353

Values are presented as n (%). NVG = neovascular glaucoma; PPV = pars plana vitrectomy; Intraop= intraoperation; inj. = injection; PRP = panretinal photocoagulation; PCCC = posterior continuous curvilinear capsulorhexis; Postop = postoperation.

p < 0.05;

Chi-square test.

Table 4.
Comparison of the amplitude and implict time of ERG parameters between NVG group and non-NVG group
NVG group Non-NVG group p-value,
Amp Imp§ Amp Imp Amp Imp
Rod-b wave 25.1 ± 18.8 63.9 ± 44.0 25.6 ± 17.8 86.0 ± 8.0 0.753 1.000
Maximal combined response
 a-wave 79.8 ± 53.1 25.86 ± 4.8 74.3 ± 30.6 25.4 ± 2.0 0.866 0.785
 b-wave 121.5 ± 83.9 51.4 ± 7.2 111.8 ± 46.4 50.1 ± 2.8 1.000 0.499
b/a ratio 1.4 ± 0.6 1.6 ± 0.4 0.796
Cone response
 a-wave 21.6 ± 18.0 18.9 ± 3.5 14.0 ± 6.7 19.7 ± 2.9 0.176 0.336
 b-wave 27.9 ± 14.1 42.0 ± 6.24 34.3 ± 18.3 42.7 ± 5.2 0.047 0.500
 30 Hz flicker 24.1 ± 14.5 21.1 ± 2.5 22.4 ± 13.2 19.6 ± 4.6 0.735 0.197
Sum of oscillatory potential 19.1 ± 16.2 27.7 ± ± 10.5 0.2 237

Values are presented as mean ± SD unless otherwise indicated. ERG = electroretinogram; NVG = neovascular glaucoma; Amp = amplitude; Imp = implicit.

p < 0.05;

Wilcoxon paired signed rank test;

Mean ± standard deviation of amplitude (μ V);

§ Mean ± standard deviation of implicit time (ms).

TOOLS
Similar articles