Abstract:
Purpose: Neovascular glaucoma (NVG) is a particularly challenging and
prognostically poor form of glaucoma. This research evaluated the effectiveness of
a dual treatment approach combining intraocular VEGF inhibitor injection and
microsecond pulse cyclophotocoagulation (µCPC) for managing secondary
neovascular glaucoma.
Methods: The study included 58 patients (67 eyes) suffering from secondary
neovascular glaucoma due to diabetes or thrombosis of the central retinal vein or
its branches. The best corrected visual acuity (BCVA) ranged from hand motion to
0.4, with an average initial intraocular pressure (IOP) of 42 ± 12 mm Hg. Treatment
consisted of an intraocular injection of Bevacizumab, a VEGF inhibitor, followed
within 5-7 days by 810 nm infrared diode laser application in microsecond pulse
mode at 2000 mW for a total duration of 220-240 seconds (145 – 160 J) and a duty
cycle of 33.3%. Treatment success was determined by a decrease in anti-glaucoma
drop (AGD) usage and maintaining an IOP between 11-21 mm Hg at the final followup. Follow-up assessments occurred at baseline, 1 week, and 1, 3, and 6 months
post-treatment.
Results: On average, 1.3 treatments were administered per eye, with 20 eyes (30%)
needing additional treatment with continuous-wave CPC within the first month. The
mean IOP dropped to 28.5 ± 5.0 mm Hg after 1 week, 23.0 ± 5.3 mm Hg after 1
month, 19.5 ± 3.2 mm Hg after 3 months, and 18.5 ± 2.5 mm Hg after 6 months,
showing a stable reduction in IOP starting at 3 months. The treatment was successful
in 74% of cases. The use of AGD decreased from 2.0 ± 1.0 at baseline to 1.1 ± 1.2 at
1 month, then increased to 1.7 ± 1.0 at 3 months and 2.2 ± 1.2 by 6 months. No
severe complications or hypotony were reported.
Conclusion: The combination of VEGF inhibitor injections and µCPC offers an
effective, safe, and prompt treatment for NVG over a six-month period.
