Takeuchi Masaru, Kanda Takayuki, Harimoto Kozo, Sora Daisuke, Okazawa Rina, Sato Tomohito
Department of Ophthalmology, National Defense Medical College, Tokorozawa 359-8513, Japan.
J Clin Med. 2024 May 31;13(11):3252. doi: 10.3390/jcm13113252.
The purpose of this study is to investigate outcomes of visual acuity (VA) and intraocular pressure (IOP) in proliferative diabetic retinopathy (PDR)-associated neovascular glaucoma (NVG) in Japanese patients treated with surgical therapies without the use of glaucoma drainage devices. A retrospective analysis of medical records was conducted for 31 consecutive PDR-associated NVG patients who underwent surgical treatments in our institution between 2013 and 2022. Patient demographics, clinical characteristics, VA, and IOP were recorded at the first and last visits, and surgical procedures, including pars plana vitrectomy with extensive panretinal and ciliary photocoagulation (PPV-PRCP), diode laser trans-scleral cyclophotocoagulation (DCPC), and trabeculectomy with mitomycin C (TLE-MMC), with or without a prior intravitreal bevacizumab (IVB) injection, were reviewed. Of the thirty-one PDR patients with NVG, two patients received PPV-PRCP or DCPC alone (6.5%), respectively, three patients received TLE-MMC alone (9.7%), two patients received TLE-MMC after IVB (6.5%), six patients received PPV-PRCP and TLE-MMC (19.4%), seven patients received PPV-PRCP and TLE-MMC after IVB (22.6%), five patients received PPV-PRCP and DCPC and TLE-MMC (16.1%), and four patients received PPV-PRCP and DCPC and TLE-MMC after IVB (12.9%). The VA of two patients (6.5%) deteriorated to no light perception. In all patients, the mean logMAR VA was 1.28 ± 1.05 at the first visit and remained at 1.26 ± 1.08 at the last visit, with no significant change; the mean IOP was 33.0 ± 15.2 mmHg at the initial visit and decreased significantly to 14.0 ± 7.4 mmHg at the last visit. The number of eyes with IOP ≥ 21 decreased from twenty-eight (90.3%) to three (9.7%). Although IOP in patients with IOP > 30 mmHg at the initial visit reduced to a level comparable to that of patients with IOP ≤ 30 mmHg, the IOP > 30 mmHg group received IVB more frequently and had significantly higher logMAR VA at the last visit compared to the IOP ≤ 30 mmHg group. Hypotony (<6 mmHg) was observed in four eyes (12.9%). In PDR patients with NVG, various combinations of PPV-PRCP, DCPC, and TLE-MMC after adjunctive IVB without the use of glaucoma drainage devices lowered IOP sufficiently; for these patients, neovascular regression was observed, with no further deterioration of VA. However, surgical procedures should be performed for PDR patients with NVG before visual impairment occurs. On the other hand, approximately less than 15% of patients developed blindness or low IOP.
本研究的目的是调查在不使用青光眼引流装置的情况下接受手术治疗的日本增殖性糖尿病视网膜病变（PDR）相关新生血管性青光眼（NVG）患者的视力（VA）和眼压（IOP）结果。对2013年至2022年期间在我院接受手术治疗的31例连续的PDR相关NVG患者的病历进行了回顾性分析。记录患者的人口统计学资料、临床特征、VA和IOP在首次和末次就诊时的情况，并回顾手术过程，包括伴有广泛全视网膜和睫状体光凝的玻璃体切除术（PPV-PRCP）、二极管激光经巩膜睫状体光凝（DCPC）以及丝裂霉素C小梁切除术（TLE-MMC），无论是否在术前接受过玻璃体内贝伐单抗（IVB）注射。在31例PDR合并NVG患者中，分别有2例患者单独接受了PPV-PRCP或DCPC（6.5%），3例患者单独接受了TLE-MMC（9.7%），2例患者在IVB后接受了TLE-MMC（6.5%），6例患者接受了PPV-PRCP和TLE-MMC（19.4%），7例患者在IVB后接受了PPV-PRCP和TLE-MMC（22.6%），5例患者接受了PPV-PRCP、DCPC和TLE-MMC（16.1%），4例患者在IVB后接受了PPV-PRCP、DCPC和TLE-MMC（12.9%）。2例患者（6.5%）的视力恶化至无光感。在所有患者中，首次就诊时平均logMAR视力为1.28±1.05，末次就诊时仍为1.26±1.08，无显著变化；初始就诊时平均IOP为33.0±15.2 mmHg，末次就诊时显著降至14.0±7.4 mmHg。IOP≥21的眼数从28只（90.3%）降至3只（9.7%）。尽管初始就诊时IOP>30 mmHg的患者的IOP降至与IOP≤30 mmHg的患者相当的水平，但IOP>30 mmHg组比IOP≤30 mmHg组更频繁地接受IVB，且末次就诊时logMAR视力显著更高。4只眼（12.9%）出现低眼压（<6 mmHg）。在PDR合并NVG患者中，在不使用青光眼引流装置的情况下，辅助IVB后PPV-PRCP、DCPC和TLE-MMC的各种组合可充分降低IOP；对于这些患者，可以观察到新生血管消退，VA无进一步恶化。然而，对于PDR合并NVG患者，应在视力损害发生之前进行手术。另一方面，约不到15%的患者出现失明或低眼压。
