Prognostic Factors for Neovascular Glaucoma after Vitrectomy in Eyes with Proliferative Diabetic Retinopathy

Yeom Myeong In; Nam Eok Kim; Soo Jung Lee; Jung Min Park

doi:10.3341/jkos.2015.56.8.1229

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

Original Article

J Korean Ophthalmol Soc 2015;56(8):1229-1235.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1229

Prognostic Factors for Neovascular Glaucoma after Vitrectomy in Eyes with Proliferative Diabetic Retinopathy

Yeom Myeong In, M.D¹, Nam Eok Kim, MD², Soo Jung Lee, MD, PhD³, Jung Min Park, MD, PhD^1,

Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

Cheonan Kim’s Eye Clinic, Cheonan, Korea

Department of Ophthalmology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Jung Min Park, MD, PhD Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 600-730, Korea Tel: 82-51-461-2540, Fax: 82-51-465-7470 E-mail: pjm1438@hanmail.net

∗ This study was presented as an e-poster at the 110th Annual Meeting of the Korean Ophthalmological Society 2013.

Received 29 January 20159 March 2015 Accepted 4 June 2015

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 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.

Keywords: Neovascular glaucoma, Proliferative diabetic retinopathy, Vitrectomy

References

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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).

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