Intravitreal Bevacizumab and Subsequent Trabeculectomy with Mitomycin C for Neovascular Glaucoma with Previous Sutureless Vitrectomy

Keun Heung Park; Hyo Chul Lim; Ji Woong Lee

doi:10.3341/jkos.2016.57.4.607

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Park, Lim, and Lee: Intravitreal Bevacizumab and Subsequent Trabeculectomy with Mitomycin C for Neovascular Glaucoma with Previous Sutureless Vitrectomy

Original Article

J Korean Ophthalmol Soc 2016;57(4):607-613.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.607

Intravitreal Bevacizumab and Subsequent Trabeculectomy with Mitomycin C for Neovascular Glaucoma with Previous Sutureless Vitrectomy

Keun Heung Park, MD¹, Hyo Chul Lim, MD¹, Ji Woong Lee, MD, PhD^1,^2,

¹Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Address reprint requests to Ji Woong Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: 82-51-240-7326, Fax: 82-51-242-7341 E-mail: alertlee@naver.com

Received 10 December 2015 Revised 6 February 2016 Accepted 12 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of intravitreal bevacizumab and subsequent trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG) in eyes that underwent previous 23-gauge transconjunctival sutureless vitrectomy (TSV).

Methods

This was a retrospective, comparative, and consecutive case series study. We reviewed the medical records of patients with NVG who underwent trabeculectomy with MMC after intravitreal bevacizumab (1.25 mg/0.05 mL) injection and compared the surgical outcomes according to 23-gauge TSV history. Surgical success was defined as an intraocular pressure (IOP) of ≥6 mm Hg and ≤21 mm Hg without additional glaucoma surgery or loss of light perception. The main outcome measures were postoperative IOP control, visual acuity, and complications.

Results

A total of 27 patients (27 eyes) were included; 12 patients with 23-gauge TSV history (TSV group) and 15 patients without vitrectomy history (nonvitrectomized group). The cumulative probability of success after trabeculectomy with MMC was 82.5% and 73.3% after one year for the TSV group and the nonvitrectomized group, respectively (p = 0.523). Mean IOP decreased from 37.3 ± 9.0 mm Hg preoperatively to 12.8 ± 6.2 mmHg at the final visit in the TSV group (p = 0.002). Mean IOP decreased from 40.3 ± 9.7 mm Hg preoperatively to 17.8 ± 11.7 mm Hg at the final visit in the nonvitrectomized group (p = 0.001). Preoperative and final IOP were not significantly different between the two groups. Complications were comparable between the groups.

Conclusions

Intravitreal bevacizumab injection and subsequent trabeculectomy with MMC is an effective method for controlling IOP in patients with NVG associated with sutureless vitrectomy.

Keywords: Intravitreal bevacizumab injection, Neovascular glaucoma, Trabeculectomy with mitomycin C, Transconjuctival sutureless vitrectomy

References

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Figure 1.

Changes in mean IOP after intravitreal bevacizumab injection and trabeculectomy with MMC. IOP at each time point was not significantly different between the two groups during the entire study period. The figures indicate the number of patients followed-up at the time (nonvitrectomized group/TSV group). The error bars are 95% confidence intervals (mean ± SE × 1.96). IOP = intraocular pressure; MMC = mitomycin C; TSV = transconjunctival sutureless vitrectomy; SE = standard error; Pre-OP = preoperative.

Figure 2.

Cumulative probabilities of surgical success after intravitreal bevacizumab injection and subsequent trabeculectomy with MMC in the TSV group (solid line) and nonvitrectomized group (dotted line). The success rate was not statistically significantly different between the two groups (p = 0.523; Mantel-Cox log rank test). The figures under the horizontal axis represent the number of patients followed-up at the noted time (nonvitrectomized group/TSV group). MMC = mitomycin C; TSV = transconjunctival sutureless vitrectomy.

Table 1.

Demographic and clinical characteristics of the study patients

	TSV group	Nonvitrectomized group	p-value between two groups
Age (years)	53.4 ± 8.4	54.0 ± 11.1	1.00
Follow up (months)	13.4 ± 5.6 (range 6-25)	16.7 ± 8.9 (range 6-35)	0.72
Right eyes/left eyes	5/7	6/9	0.93
Male/female	6/6	9/6	0.60
Cause of NVG
PDR	11	9
CRVO	1	4	0.28
OIS	0	2
Pseudophakia/phakia	9/3	7/8	0.14
History of previous PRP	12/12	14/15	0.36
PAS (°)	166.4 ± 172.0	252.0 ± 134.1	0.26

Values are presented as mean ± SD unless otherwise indicated.

TSV = transconjunctival sutureless vitrectomy; NVG = neovascular glaucoma; PDR = proliferative diabetic retinopathy; CRVO = central retinal vein occlusion; OIS = ocular ischemic syndrome; PRP = panretinal photocoagulation; PAS = peripheral anterior synechia.

Table 2.

Preoperative and postoperative IOP in the study groups

	TSV group	Nonvitrectomized group	p-value between two groups
Pre-bevacizumab injection IOP (mm Hg)	35.8 ± 7.4	40.6 ± 10.5	0.32
Preoperative IOP (mm Hg)	37.3 ± 9.0	40.3 ± 9.7	0.35
IOP at final visit (mm Hg)	12.8 ± 6.2	17.8 ± 11.7	0.30
p-value	0.002^*	0.001^*

Values are presented as mean ± SD unless otherwise indicated.

IOP = intraocular pressure; TSV = transconjunctival sutureless vitrectomy.

^* p-value between preoperative IOP and IOP at final visit.

Table 3.

The changes in mean number of glaucoma medications in the study groups

	TSV group	Nonvitrectomized group	p-value between two groups
Preop. number of medications	3.92 ± 0.29	3.53 ± 0.52	0.08
Postop. number of medications	0.67 ± 1.23	1.07 ± 1.33	0.40
p-value	0.002^*	0.001^*

Values are presented as mean ± SD unless otherwise indicated.

TSV = transconjunctival sutureless vitrectomy; Preop. = preoperative; Postop. = postoperative.

^* p-value between preop. and postop. number of medications.

Table 4.

The changes in mean BCVA (log MAR) in the study groups

	TSV group	Nonvitrectomized group	p-value between two groups
Preop. BCVA	1.7 ± 0.9	1.4 ± 1.1	0.37
Postop. BCVA	1.65 ± 1.1	1.57 ± 1.2	0.76
p-value	0.55^*	0.71^*

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best-corrective visual acuity; TSV = transconjunctival sutureless vitrectomy; Preop. = preoperative; Postop. = postoperative.

^* p-value between preop. and postop. BCVA.

Table 5.

Postoperative complications in the study groups

	TSV group	Nonvitrectomized group	p-value between groups
Hyphema	4 (33.3)	3 (20.0)	1.000
Vitreous hemorrhage	1 (8.3)	1 (6.7)	1.000
Bleb leakage	0 (0)	1 (6.7)	1.000
Choroidal effusion	0 (0)	1 (6.7)	1.000

Values are presented as n (%).

TSV = transconjunctival sutureless vitrectomy.

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