Cyclocryotherapy applied at the 3 o'clock and 9 o'clock positions combined with anti-VEGF injections for advanced neovascular glaucoma.

OBJECTIVE

This study aimed to investigate the efficacy of cyclocryotherapy applied at the 3 o'clock and 9 o'clock positions in combination with intravitreal anti-vascular endothelial growth factor (VEGF) injections in patients with advanced neovascular glaucoma (NVG).

METHODS

Medical records of patients diagnosed with NVG who underwent cyclocryotherapy at the 3 o'clock and 9 o'clock positions combined with intravitreal anti-VEGF injections between January 2021 and January 2023 were retrospectively reviewed. Baseline and follow-up data including intraocular pressure (IOP), best-corrected visual acuity, perioperative pain scores using numeric rating scale, intraocular cytokines levels, and surgical complications, were analyzed. A successful surgical outcome was defined as an IOP below 21 mmHg with at least a 30% reduction from baseline.

RESULTS

A total of 20 eyes from 20 patients were included. Elevated levels of several inflammatory mediators and angiogenic cytokines were detected in aqueous and vitreous samples. Pain scores significantly decreased scores at one month postoperatively (0.5±0.9) compared to preoperative values (6.2±3.0) (P<0.001). At the 3-month follow up, the mean IOP was 26.4±15.9 mmHg, representing a 39.0% reduction from baseline (43.2±10.6 mmHg) (P=0.003). At the final follow-up visit (mean duration 13.3±4.5 months), the mean IOP was 26.6±15.2 mmHg, corresponding to a 38.4% reduction from baseline. No cases of anterior segment ischemia or phthisis bulbi were documented during the follow-up period. The surgical success rate was 55% at 3 months and 60% at the final follow-up.

CONCLUSIONS

Cyclocryotherapy applied at the 3 o'clock and 9 o'clock position combined with anti-VEGF treatment presents a potential treatment alternative for advanced NVG. Further research is needed to validate its long-term efficacy and safety profile.