Increased interleukin-6 in aqueous humor of neovascular glaucoma.
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PURPOSE: To demonstrate the involvement of proinflammatory cytokines in intraocular neovascularization by detecting the presence of interleukin (IL)-6, IL-2, and tumor necrosis factor (TNF)-alpha in aqueous humor and serum of patients with neovascular glaucoma (NVG) secondary to central retinal vein occlusion (CRVO). METHODS: According to the grade of iris neovascularization (NVI), patients with CRVO were divided into three groups: CRVO without NVI, CRVO with NVI, and CRVO with regressed NVI. Healthy patients with cataract were enrolled as control subjects. Enzyme-linked immunosorbent assay was used to quantitate the concentrations of the cytokines IL-6, IL-2, and TNF-alpha in aqueous humor and serum from patients with NVG and control subjects. RESULTS: In serum, the levels of IL-6, IL-2, and TNF-alpha did not differ among groups. In aqueous humor, only IL-6 showed significant change among groups. IL-6 levels in aqueous humor of group 2, CRVO with NVI (1532.0+/-221.1 pg/ml; P < 0.001), and group 3, CRVO with regressed NVI (234+/-154.6 pg/ml; P < 0.001), were significantly higher. There was no significant difference in IL-6 levels between the control group (26.4+/-21.8 pg/ml) and group 1 (15.6+/-0.9 pg/ml). CONCLUSIONS: The inflammatory cytokine IL-6 in aqueous humor increased spatially and temporally correlated with the grade of NVI in patients of NVG secondary to CRVO. The aqueous IL-6 increased in NVI and decreased after vessels regressed. It is possible that the significantly higher level of IL-6 was due to intraocular synthesis because of the minimal change in serum. The increased level of IL-6 may have a putative role along with other angiogenic factors in angiogenesis of NVG as a possible predictor of NVI. (+info)
Endoscopic laser photocoagulation for management of neovascular glaucoma.
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We used endoscopic laser photocoagulation to treat neovascular glaucoma in eight eyes of seven patients. New vessels of the iris and anterior chamber disappeared or stabilized after photocoagulation in seven eyes (88%), while the vision improved in four eyes (50%). The endoscopy was excellent for observing the peripheral retina and ciliary process tissue. We found the endoscopic laser was suitable for wider photocoagulation of ischemic retina against media opacity. (+info)
Survival analysis for success of Molteno tube implants.
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AIM: To apply survival analysis in assessing the long term outcome of Molteno tube implantation and to identify risk factors for failure. METHODS: A retrospective, 10 year, consecutive case series study of 119 eyes that underwent implantation of a Molteno tube. The main outcome measures considered were intraocular pressure (IOP), visual acuity, and complications. RESULTS: A 30% or greater reduction in IOP was achieved in 68.9% of cases. However, the overall, "complete success" rate (IOP <22 mm Hg with no medications) after a mean (SD) follow up period of 43 (33) months (range 6-120) was only 33.6% despite a fall in mean (SD) IOP from 38.2 (8.2) mm Hg to 20.1 (11.0) mm Hg. The "qualified success" rate (IOP <22 mm Hg with or without medications) was 60.5%. Failure was most common in the first postoperative year but could occur after several years, the survival curve having an exponential shape. The only statistically significant risk factor for failure identified was pseudophakia, although eyes with neovascular glaucoma tended to fare poorly. Postoperative IOP tended to be lower after double plate than after single plate implantation. There was no significant difference in outcome based on age, sex, race, previous penetrating keratoplasty, or previous conjunctival surgery. CONCLUSIONS: In eyes at high risk of trabeculectomy failure, implantation of an aqueous shunt device should be considered. Pseudophakia should be considered an additional risk factor for failure. Early failure appeared relatively more common but long term follow up of all cases is recommended to ensure adequate management of late failures. (+info)
Serum factors associated with neovascular glaucoma following vitrectomy for proliferative diabetic retinopathy.
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We performed a retrospective study of serum factors associated with neovascular glaucoma that can occur following vitrectomy for proliferative diabetic retinopathy. The medical records of 183 patients (241 eyes) who received vitrectomy between August 1996 and August 2000 were studied retrospectively and subsequently analyzed by linear logistic regression analysis and multiple logistic regression tests. Neovascular glaucoma developed at an average of 2.7 months in 31 of 241 eyes (14.1%). The overall anatomical success rate of retinal attachment was 82.5% (199 eyes in 241 eyes), although it decreased to 45.1% (14 eyes in 31 eyes) in eyes with neovascular glaucoma. Serum cholesterol (P = 0.041) and fibrinogen levels (P = 0.020) were significantly associated with the development of neovascular glaucoma. However, no significant association could be found concerning hypertension, diabetic retinopathy or hypercholesterolemia (P > 0.05). We suggest that serum creatinine, cholesterol and fibrinogen levels can be used to predict the development of neovascular glaucoma in vitrectomized eyes with diabetic retinopathy and can further provide a more active approach to preventing the development of this condition. (+info)
Mid-term effects of trabeculectomy with mitomycin C in neovascular glaucoma patients.
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Twenty four eyes from 23 neovascular glaucoma (NVG) patients, who underwent trabeculectomy with 0.2 or 0.4 mg/ml MMC in least the previous 6 months, were examined in order to evaluate the mid-term effects of a trabeculectomy with mitomycin C (MMC) in NVG. Success defined when an intraocular pressure (IOP) < 22 mmHg and > 5 mmHg with or without medication was observed. The mean IOP was reduced from 46.8+/-12.9 mmHg preoperatively to 18.2+/-12.0 mmHg at the last follow-up (mean = 25.8 months). The overall success rates at 1-, 3-, 6-, 9-, and 12-months after surgery were 71%, 58%, 50%, 29%, 29% respectively. The number of anti-glaucoma medications administered was significantly reduced from 2.6+/-0.7 preoperatively to 0.9+/-1.0 postoperatively (Wilcoxon signed rank test, p = 0.005). In addition both the intraoperative MMC concentration and application time had no influence on lowering the IOP (logistic regression analysis, p = 0.228, 0.910, respectively). There was a similar incidence of postoperative complications in both the success and failure group. These results suggest that a trabeculectomy with MMC is an effective surgical procedure in NVG patients and the MMC concentration is not crucial for reducing the IOP postoperatively. (+info)
Mitomycin-C-augmented trabeculectomy for neovascular glaucoma. A preliminary report.
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PURPOSE: This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP. RESULTS: The mean IOP decreased from 38.6 +/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 +/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6%) of 15 eyes improved vision or retained preoperative vision, one (6.7%) eye lost light perception and one (6.7%) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7%) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 +/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis. CONCLUSION: Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG. (+info)
Retinectomy for treatment of intractable glaucoma: long term results.
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AIM: To report long term efficacy and complications of retinectomy as an intraocular pressure lowering procedure for intractable glaucoma. METHODS: This was a consecutive interventional case series. In 44 consecutive eyes (39 patients, 22 men and 17 women) retinectomy was performed to lower the intraocular pressure (IOP) in patients with uncontrolled IOP (>35 mm Hg for more than 4 months) despite conventional filtering surgery and drug treatment. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by an intraocular gas tamponade of 20% C(3)F(8). Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (three eyes), secondary glaucoma due to aphakia (13 eyes), severe ocular trauma (seven eyes), uveitis (seven eyes), and glaucoma in Ehlers-Danlos syndrome (two). RESULTS: All patients underwent successful surgical retinectomy. All patients were followed for 5 years. Mean postoperative IOP after 4 years was 15.7 (SD 9.4) mm Hg, representing a decrease of IOP by 61% compared to the preoperative level (41.2 (9.4) mm Hg). In 52.3% of eyes long term regulation of IOP could be achieved without complications. Retinectomy was least effective in neovascular glaucoma because of central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed a tendency towards low IOP levels with subsequent phthisis bulbi. The initial visual acuity of all patients was lower than 20/50 (mean 1.8 (0.8) logMAR) in the treated eye. Final visual acuity was 2.3 (0.6) logMAR. 21 out of 44 cases developed retinal complications (retinal detachment or proliferative vitreoretinopathy (PVR)) after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for PVR. Nine eyes developed phthisis, seven of which were enucleated during the follow up. CONCLUSIONS: Long term results after retinectomy demonstrate its efficacy in otherwise intractable glaucoma. Efficacy and safety of retinectomy are dependent on the underlying disease. (+info)
A pilot study of pars plana vitrectomy, intraocular gas, and radial neurotomy in ischaemic central retinal vein occlusion.
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BACKGROUND/AIMS: There is no effective treatment for ischaemic central retinal vein occlusion (CRVO). The two major negative outcomes are neovascular glaucoma (NVG) and severe central visual loss. In this study pars plana vitrectomy (PPV), mild panretinal photocoagulation, and intraocular gas injection were employed to prevent NVG. The potential role of incision of the lamina cribrosa (radial neurotomy) for visual recovery was examined. METHODS: Eight eyes of seven patients with ischaemic CRVO had PPV, mild panretinal photocoagulation, and intraocular perfluoropropane gas injection. Four eyes had radial neurotomies performed. The patients were examined by fundus photography, fundus fluorescein angiography, optical coherence tomography, and Goldmann visual field analysis. RESULTS: No patients suffered from neovascular glaucoma. Visual recovery was seen in patients with and without neurotomy but some patients had cataract extraction to allow visualisation for PPV. Fundus photography demonstrated reduced engorgement of retinal veins in two of the patients with neurotomy and one with PPV alone. Optical coherence tomography demonstrated macular oedema in three patients with neurotomy and all patients with PPV alone. Segmental visual field loss was seen in one patient with neurotomy suggesting damage to the optic nerve head. CONCLUSIONS: PPV is safe in ischaemic CRVO. Combined with mild PRP and intraocular gas injection the risk of neovascular glaucoma is low. Neurotomy can be added to try to improve the chances of recovery of central vision but may cause additional peripheral visual field loss. (+info)