Risk factors associated with neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhang Peng ,  Shang Qingli , Ma Jingxue , Ye Cunxi , Hao Yuhua , Yao Yimin

Department of Ophthalmology, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;

Corresponding author：

Shang Qingli, Email: qinglishang2013@sina.com

Keywords：

Glaucoma, neovascular/etiology; Diabetic retinopathy/surgery; Vitrectomy; Root cause analysis

DOI：

10.3760/cma.j.issn.1005-1015.2017.03.012

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.

Citation： Zhang Peng, Shang Qingli, Ma Jingxue, Ye Cunxi, Hao Yuhua, Yao Yimin. Risk factors associated with neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2017, 33(3): 271-274. doi: 10.3760/cma.j.issn.1005-1015.2017.03.012 Copy

1.	Newman DK. Surgical management of the late complications of proliferative diabetic retinopathy[J]. Eye(Lond), 2010, 24(3): 441-449. DOI: 10.1038/eye.2009.325.
2.	Goto A, Inatani M, Inoue T, Frequency and risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J]. J Glaucoma, 2013, 22(7): 572-576. DOI: 10.1097/IJG.0b013e31824d514a.
3.	张彦来, 官思远. 糖尿病视网膜病变手术后继发新生血管青光眼的危险因素[J]. 重庆医科大学学报, 2014, 39(8): 1110-1113. DOI: 10.13406/j.cnki.cyxb.000111.Zhang YL, Guan SY. Risk factors of secondary neovascular glaucoma after vitrectomy for proliperative diabetic retinapathy[J]. Journal of Chongqing Medical University, 2014, 39(8): 1110-1113. DOI: 10.13406/j.cnki.cyxb.000111.
4.	曹丹, 张良, 黄中宁, 等. 增生型糖尿病视网膜病变玻璃体切割手术后新生血管性青光眼的危险因素分析[J]. 中华眼底病杂志, 2015, 31(2): 147-149. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.009.Cao D, Zhang L, Huang ZN, et al. Risk factor analysis for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2015, 31(2): 147-149. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.009.
5.	Osaadon P, Fagan XJ, Lifshitz T, et al. A review of anti-VEGF agents for proliferative diabetic retinopathy[J]. Eye (Lond), 2014, 28(5): 510-520. DOI: 10.1038/eye.2014.13.
6.	刘海芸, 宋正宇, 刘堃, 等. 23G和20G玻璃体切割手术治疗糖尿病视网膜病变的有效性和安全性比较[J]. 中华眼底病杂志, 2012, 28(2), 138-141. DOI: 10.3760/cma.j.issn.1005-1015.2012.02.008.Liu HY, Song ZY, Liu K, et al. Comparison of 23G and 20G vitrectomy for diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2012, 28(2), 138-141. DOI: 10.3760/cma.j.issn.1005-1015.2012.02.008.
7.	郦晓霞, 吴苗琴. 糖尿病视网膜病变性新生血管性青光眼的治疗进展[J]. 中华眼外伤职业眼病杂志, 2015, 37(2), 157-160. DOI: 10.3760/cma.j.issn.2095-1477.2015.02.023.Li XX, Wu MQ. Advance in treatment of neovascular glaucoma associated with diabetic retinopathy[J]. Chin J Ocul Traum Occupat Eye Dis, 2015, 37(2), 157-160. DOI: 10.3760/cma.j.issn.2095-1477.2015.02.023.
8.	陶勇, 姜燕荣, 黎晓新, 等. 增殖型糖尿病视网膜病变玻璃体手术与虹膜红变发生的关系[J]. 中华糖尿病杂志, 2005, 13(5), 332-334. DOI: 10.3321/j.issn.1006-6187.2005.05.006.Tao Y, Jiang YR, Li XX, et al. Rubeosis iridis after vitrectomy for proliferative diabetic retinopathy[J]. Chin J Diabetes, 2005, 13(5), 332-334. DOI: 10.3321/j.issn.1006-6187.2005.05.006.
9.	Hong SP, Park YW, Lee CW, et al. Usefulness of the Doppler flow of the ophthalmic artery in the evaluation of carotid and coronary atherosclerosis[J]. Korean Circ J, 2014, 44(6): 406-414. DOI: 10.4070/kcj.2014.44.6.406.
10.	Pe’er J, Folberg R, Itin A, et al. Upregulated expression of vascular endothelial growth factor in proliferative diabetic retinopathy[J]. Br J Ophthalmol, 1996, 80(3): 241-245.
11.	Sone H, Okuda Y, Kawakami Y, et al. Vascular endothelial growth factor level in aqueous humor of diabetic patients with rubeotic glaucoma is markedly elevated[J]. Diabetes Care, 1996, 19(11): 1306-1307.
12.	Kozawa T, Sone H, Okuda Y, et al. Vascular endothelial growth factor levels in the aqueous and serum in diabetic retinopathy with or without neovascular glaucoma[J]. Nippon Ganka Gakkai Zasshi, 1998, 102(11): 731-738.
13.	Hu DN, Ritch R, Liebmann J, et al. Vascular endothelial growth factor is increased in aqueous humor of glaucomatous eyes[J]. J Glaucoma, 2002, 11(5): 406-410.
14.	Summanen P. Neovascular glaucoma following vitrectomy for diabetic eye disease[J]. Acta Ophthalmol (Copenh), 1988, 66(1): 110-116.
15.	Itakura H, Kishi S, Kotajima N, et al. Persistent secretion of vascular endothelial growth factor into the vitreous cavity in proliferative diabetic retinopathy after vitrectomy[J]. Ophthalmology, 2004, 111(10): 1880-1884.
16.	Wakabayashi Y, Usui Y, Okunuki Y, et al. Intraocular VEGF level as a risk factor for postoperative complications after vitrectomy for proliferative diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2012, 53(10): 6403-6410.
17.	梁建宏, 黎晓新. 增生型糖尿病视网膜病变玻璃体切割手术中眼内填充物和抗血管内皮生长因子药物应用利弊[J]. 中华眼底病杂志, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.Liang JH, Li XX. The advantages and disadvantages of intraocular tamponade and anti-vascular endothelial growth factor drugs in vitrectomy for proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.

1. Newman DK. Surgical management of the late complications of proliferative diabetic retinopathy[J]. Eye(Lond), 2010, 24(3): 441-449. DOI: 10.1038/eye.2009.325.
2. Goto A, Inatani M, Inoue T, Frequency and risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J]. J Glaucoma, 2013, 22(7): 572-576. DOI: 10.1097/IJG.0b013e31824d514a.
3. 张彦来, 官思远. 糖尿病视网膜病变手术后继发新生血管青光眼的危险因素[J]. 重庆医科大学学报, 2014, 39(8): 1110-1113. DOI: 10.13406/j.cnki.cyxb.000111.Zhang YL, Guan SY. Risk factors of secondary neovascular glaucoma after vitrectomy for proliperative diabetic retinapathy[J]. Journal of Chongqing Medical University, 2014, 39(8): 1110-1113. DOI: 10.13406/j.cnki.cyxb.000111.
4. 曹丹, 张良, 黄中宁, 等. 增生型糖尿病视网膜病变玻璃体切割手术后新生血管性青光眼的危险因素分析[J]. 中华眼底病杂志, 2015, 31(2): 147-149. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.009.Cao D, Zhang L, Huang ZN, et al. Risk factor analysis for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2015, 31(2): 147-149. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.009.
5. Osaadon P, Fagan XJ, Lifshitz T, et al. A review of anti-VEGF agents for proliferative diabetic retinopathy[J]. Eye (Lond), 2014, 28(5): 510-520. DOI: 10.1038/eye.2014.13.
6. 刘海芸, 宋正宇, 刘堃, 等. 23G和20G玻璃体切割手术治疗糖尿病视网膜病变的有效性和安全性比较[J]. 中华眼底病杂志, 2012, 28(2), 138-141. DOI: 10.3760/cma.j.issn.1005-1015.2012.02.008.Liu HY, Song ZY, Liu K, et al. Comparison of 23G and 20G vitrectomy for diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2012, 28(2), 138-141. DOI: 10.3760/cma.j.issn.1005-1015.2012.02.008.
7. 郦晓霞, 吴苗琴. 糖尿病视网膜病变性新生血管性青光眼的治疗进展[J]. 中华眼外伤职业眼病杂志, 2015, 37(2), 157-160. DOI: 10.3760/cma.j.issn.2095-1477.2015.02.023.Li XX, Wu MQ. Advance in treatment of neovascular glaucoma associated with diabetic retinopathy[J]. Chin J Ocul Traum Occupat Eye Dis, 2015, 37(2), 157-160. DOI: 10.3760/cma.j.issn.2095-1477.2015.02.023.
8. 陶勇, 姜燕荣, 黎晓新, 等. 增殖型糖尿病视网膜病变玻璃体手术与虹膜红变发生的关系[J]. 中华糖尿病杂志, 2005, 13(5), 332-334. DOI: 10.3321/j.issn.1006-6187.2005.05.006.Tao Y, Jiang YR, Li XX, et al. Rubeosis iridis after vitrectomy for proliferative diabetic retinopathy[J]. Chin J Diabetes, 2005, 13(5), 332-334. DOI: 10.3321/j.issn.1006-6187.2005.05.006.
9. Hong SP, Park YW, Lee CW, et al. Usefulness of the Doppler flow of the ophthalmic artery in the evaluation of carotid and coronary atherosclerosis[J]. Korean Circ J, 2014, 44(6): 406-414. DOI: 10.4070/kcj.2014.44.6.406.
10. Pe’er J, Folberg R, Itin A, et al. Upregulated expression of vascular endothelial growth factor in proliferative diabetic retinopathy[J]. Br J Ophthalmol, 1996, 80(3): 241-245.
11. Sone H, Okuda Y, Kawakami Y, et al. Vascular endothelial growth factor level in aqueous humor of diabetic patients with rubeotic glaucoma is markedly elevated[J]. Diabetes Care, 1996, 19(11): 1306-1307.
12. Kozawa T, Sone H, Okuda Y, et al. Vascular endothelial growth factor levels in the aqueous and serum in diabetic retinopathy with or without neovascular glaucoma[J]. Nippon Ganka Gakkai Zasshi, 1998, 102(11): 731-738.
13. Hu DN, Ritch R, Liebmann J, et al. Vascular endothelial growth factor is increased in aqueous humor of glaucomatous eyes[J]. J Glaucoma, 2002, 11(5): 406-410.
14. Summanen P. Neovascular glaucoma following vitrectomy for diabetic eye disease[J]. Acta Ophthalmol (Copenh), 1988, 66(1): 110-116.
15. Itakura H, Kishi S, Kotajima N, et al. Persistent secretion of vascular endothelial growth factor into the vitreous cavity in proliferative diabetic retinopathy after vitrectomy[J]. Ophthalmology, 2004, 111(10): 1880-1884.
16. Wakabayashi Y, Usui Y, Okunuki Y, et al. Intraocular VEGF level as a risk factor for postoperative complications after vitrectomy for proliferative diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2012, 53(10): 6403-6410.
17. 梁建宏, 黎晓新. 增生型糖尿病视网膜病变玻璃体切割手术中眼内填充物和抗血管内皮生长因子药物应用利弊[J]. 中华眼底病杂志, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.Liang JH, Li XX. The advantages and disadvantages of intraocular tamponade and anti-vascular endothelial growth factor drugs in vitrectomy for proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 527-528. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.016.

Chinese Journal of Ocular Fundus Diseases

Risk factors associated with neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content