Combined vitrectomy, near-confluent endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma

Purpose Evaluated the safety and efficacy of an integrative surgical approach to neovascular glaucoma (NVG). Methods Consecutive interventional case series of NVG with one-year follow-up. Eyes underwent pars plana vitrectomy, near-confluent panretinal photocoagulation, intravitreal bevacizumab, and transscleral cyclophotocoagulation. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), glaucoma medication score (GMS), visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6 and 12 months. Blind eyes were excluded. Results 83 eyes of 83 patients (53 male, 30 female, mean age 74.6±11.6 years) were included and 53 completed a one-year follow-up. NVG underlying conditions included retinal vein occlusion (n=41), proliferative diabetic retinopathy (n=25), central retinal artery occlusion (n=10), and ocular ischemic syndrome (n=6). Mean IOP decreased postoperatively from 46.0±10.3 mmHg to 14.2±8.9 mmHg (p<0.001), GMS from 4.8 to 1.8 (p<0.001) and VAPS from 6 to 0. BCVA was unchanged. All postoperative complications had resolved at 1 month postop. 26 eyes did not require additional surgical treatment during follow-up. Conclusions A single, comprehensive surgery session was able to significantly lower IOP, reduce GMS and control pain.