Vitreoretinal surgery in the treatment of neovascular glaucoma

Purpose Neovascular glaucoma develops on a background of ischemic ocular pa thologies, such as diabetic eye diseases or central retinal vein occlusion. Development of neovascular membranes in the chamber angle leads to elevate d intraocular pressure. Since treatment by cyclodestructive therapy or drai nage surgery often fails, we have examined intense antiproliferative surger y as a treatment for advanced neovascular glaucoma. Patients and Methods Thirty-two patients with neovascular glaucoma subseque nt to central vein occlusion or advanced diabetic retinopathy underwent ant iproliferative surgery, which comprised vitrectomy, panretinal laser treatm ent and direct laser coagulation of the ciliary processes, followed by sili cone oil tamponade. Patients were followed for a minimum of 1 year and as l ong as 3 years. Results After one week following surgery the intraocular pressure (IOP) was normal, ranging from 8 to 21 mm#Hg, in 52% (15/29 eyes), after 3 months th e IOP was normal in 50% (16/32 eyes), after 6 months the IOP was normal in 59% (16/27 eyes) and after 1 year the IOP was normal in 72% (18/25 eyes). O f the 10 eyes that lost all sight after the surgery, 7 eyes had a history o f central vein occlusion. Hypotony was observed in 6% (2/32) of the eyes 3 months following surgery; after 6 months hypotony was present in 15% (4/27) of the eyes and after 1 year hypotony was present in 12% (3/25) of the eye s. Conclusions The theoretical premise of our surgical intervention (antiproli ferative surgery) is based on the assumption that laser treatment interrupt s the self enhancing pathway of retinal ischemia, release of proliferative factors and increase in intraocular pressure. The silicone oil endotamponad e prevents postoperative complications and supports the rapid regression of rubeosis iridis by separating the anterior from the posterior segment.