Pars plana vitrectomy, endolaser coagulation of the retina and the ciliarybody combined with silicone oil endotamponade in the treatment of uncontrolled neovascular glaucoma

Purpose: Neovascular glaucoma develops on a background of ischemic ocular p athologies,such as diabetic eve diseases or central retinal vein occlusion. Development of neovascular membranes in the chamber angle leads to elevate d intraocular pressure (IOP). Since cy clodestructive therapy or drainage s urgery often fails, we have examined intense antiproliferative surgery as a treatment for advanced neovascular glaucoma. Patients and methods: Thirty-two patients with uncontrolled neovascular gla ucoma (mean IOP 45.5 mmHg) subsequent to central retinal vein occlusion or advanced diabetic retinopathy underwent antiproliferative surgery, which co mprised pars plana vitrectomy, panretinal laser treatment and direct laser coagulation of the ciliary processes, followed by silicone oil tamponade. P atients were followed up for a minimum of 1 year and as long as 3 years. Results: One week following surgery the IOP was normal, ranging from 8 to 2 1 mmHg, in 52% of eyes (15/29). After 3 months the IOP was normal in 50% (1 6/32); after 6 months, in 59% (16/27); and after 1 year, in 72% (18/25). Of the 10 eyes that lost all sight after the surgery, 7 eyes had a history of central retinal vein occlusion. Hypotony was observed in 6% of the eyes (2 /32) 3 months after surgery; after 6 months hypotony was present in 15% (4/ 27), and after 1 year hypotony was present in 12% (3/25). Conclusions: The theoretical premise of our surgical intervention (antiprol iferative surgery) is that laser treatment interrupts the self-enhancing pa thway of retinal ischemia, release of proliferative factors and increase in intraocular pressure. The silicone oil endotamponade prevents postoperativ e complications and supports the rapid regression of rubeosis iridis by sep arating the anterior from the posterior segment.