Aim of this study was to analyse the management of neovascular glaucoma (NVG) in patients with diabetes mellitus and assess the visual outcome. A retrospective case series was conducted. 20 diabetic ...patients with NVG who attended the retina clinic over a period of 1 year were taken for the study and were followed up for 6 months to 1 year. Among them, 15 patients had an effectively controlled intraocular pressure (IOP) after the treatment (16.68 ± 4.69 mmHg) as compared to the pre-treatment levels (42.59 ± 9.44, p<0.05). There was improvement in visual acuity to a certain extent in 12 eyes (62.7%) whereas visual acuity in 4 (23.5%) eyes was noted to be ≥0.1, remained the same in 3 (17.6%) eyes, and became worse in 1 (5.8%) eye. Results showed that a comprehensive management with adequate number of pan-retinal photocoagulations (PRP), intravitreal/intracameral anti-vascular endothelial growth factor (VEGF) injections and early surgical interventions along with strict diabetic control can avert visual loss and improve the prognosis.
PurposeThis study was aimed to gauge the efficacy of primary AGV implantation with concurrent intraoperative intravitreal ranibizumab vs primary AGV implantation alone in the management of ...neovascular glaucoma (NVG). MethodsThis retrospective comparative study was carried out based on the data collected in patients of neovascular glaucoma who underwent Ahmed Glaucoma Valve implantation with or without concurrent intravitreal ranibizumab between the period from Feb 2009 to Feb 2015 involving two groups of 40 patients each, having the clinical diagnosis of neovascular glaucoma, having undergone pan-retinal photocoagulation with minimum 03 intravitreal injections of ranibizumab not less than 4 weeks prior to undergoing primary Ahmed glaucoma valve implantation and allotted randomly to either group to receive concurrent administration of intravitreal ranibizumab with Ahmed glaucoma valve (AGV) implant surgery or AGV implant surgery alone. The minimum qualifying follow-up was 3-years. The functional outcome measures included intraoperative and postoperative complications, intraocular pressure (IOP), and the need for antiglaucoma medication, if any, as well as best corrected visual acuity. ResultsBoth the groups showed a significant decrease in IOP (p < 0.05). Sight and IOP threatening postoperative complications were significantly low in the study group. NVI regression was higher in the study group and re-emergence was significantly lesser in the study group (p = 0.002). Mean postop IOP had shown an excellent reduction in IOP up to 14.25 ± 2.05 mm Hg with 1.5 ± 1 antiglaucoma drugs in ranibizumab group and 15.25 ± 2.95 mm Hg with 1.7 ± 0.87 antiglaucoma drugs in the control group at the 3-years follow-up period. Surgical success rates were comparable between the two groups at 1 and 3-year. ConclusionConcurrent intravitreal ranibizumab along with primary AGV implantation minimizes postoperative complications, regresses NVI while accelerating stabilization of IOP and visual functions. How to cite this articleKaushik J, Parihar JKS, Shetty R, et al. A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma. J Curr Glaucoma Pract 2022;16(1):41-46.
To evaluate the safety and efficacy of modified Ahmed glaucoma valve (AGV) implantation (long scleral tunnel technique) in the treatment of neovascularization glaucoma (NVG). This retrospective ...observational case series included 23 patients (23 eyes) diagnosed with NVG secondary to proliferative diabetic retinopathy from January 2020 to June 2021. All 23 cases received anti-vascular endothelial growth factor treatment. Then, after 3 to 7 days, these cases were treated with modified AGV implantation (long scleral tunnel technique) and were followed up for at least 6 months. The best corrected visual acuity, intraocular pressure, numbers of antiglaucoma medications used, and postoperative complications were observed at 1 week and 1, 3, and 6 months after treatment. With treatment, the mean best corrected visual acuity improved significantly (
P
< .001) from 1.62 ± 0.52 logMAR preoperatively to 1.29 ± 0.36 logMAR at the 6-month follow-up. The mean postoperative intraocular pressure was significantly lower than that before modified AGV implantation during follow-up period, decreasing from 45.48 ± 7.86 mm Hg preoperatively to 14.87 ± 1.96 mm Hg at 1 week, 18.39 ± 2.25 mm Hg at 1 month, 16.61 ± 1.47 mm Hg at 3 months, and 17.48 ± 1.38 mm Hg at 6 months (F = 256.646,
P
< .001). The median number of antiglaucoma medications used by patients also significantly decreased from 3 (3–4) preoperatively to 0 (0–1) at the 6-month follow-up after surgery (Z = −4.248,
P
< .001). Postoperative complications included hyphema in 2 cases and vitreous hemorrhage in 1 case, and all 3 patients achieved satisfactory recovery with treatment. No drainage tube-related complications occurred among our patients. Long scleral tunnel technique is a safe and effective surgical treatment for NVG with fewer drainage tube-related complications.
A new correlation was developed for the point of the onset of significant void (OSV) or the net vapor generation (NVG) in subcooled flow boiling. The correlation was developed based on a mechanistic ...model that assumes that the OSV occurs when the void fraction in the bubble layer formed near the heated wall reaches the critical value to cause global bubble coalescence. To achieve a good agreement with the experimental data reported in the literature, the model constant associated with the effect of the micro-convection induced by bubble growth was expressed as a function of several dimensionless numbers. For 232 experimental data points for the thermodynamic equilibrium quality at the point of OSV (POSV) reported in 22 experimental datasets, the mean absolute error was 47.8% for the original mechanistic model and it was reduced to 21.6% after the above-mentioned modification. The semi-mechanistic correlation developed in this work would hence be useful in technical applications for which the accurate prediction of the POSV is required, as in the nuclear reactor safety analysis.
ObjectivesThe aim of this study was to compare the safety and efficacy of trabeculectomy alone or combined with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents ...for the treatment of neovascular glaucoma. MethodsWe conducted a systematic review and meta-analysis to compare the effects of trabeculectomy alone or combined with intravitreal injections of anti-VEGF agents for the treatment of neovascular glaucoma. We searched four databases (PubMed, Cochrane Library, Embase, and Web of Science) up to January 2023 and extracted data on three surgical outcomes: postoperative intraocular pressure, success rate and complications. We used a random-effects model to calculate pooled relative risk (RR) or standardized mean difference (SMD) estimates and 95% confidence intervals (CIs). We assessed publication bias using Begg and Egger tests. ResultsWe included seven studies with 353 eyes. Compared to trabeculectomy alone, trabeculectomy with anti-VEGF had a lower risk of postoperative complications (RR, 0.60; 95% CI, 0.41-0.89) and higher success rate (RR, 1.19; 95% CI, 1.02-1.40). The intraocular pressure reduction was significantly greater in the trabeculectomy with anti-VEGF augmentation group than the trabeculectomy group from 1 week (SMD, -1.36; 95% CI, -2.76 to 0.04) to 6 months (SMD, -0.79; 95% CI, -1.50 to -0.07) after surgery. ConclusionsAccording to current evidence, adding intravitreal injection of anti-VEGF agents to trabeculectomy may improve the short time outcomes of patients with neovascular glaucoma.
•Mechanism of OSV in subcooled flow boiling was investigated theoretically.•OSV was supposed to be triggered by global bubble coalescence.•OSV resembles the transition from babbly to slug flows in ...two-phase flow.•Heat flux spent for vaporization was estimated using Chen's correlation.•Calculated OSV condition agreed with Saha-Zuber correlation well.
Theoretical investigation was carried out for a possible mechanism of the onset of significant void (OSV) or net vapor generation (NVG) in subcooled flow boiling. Based on available knowledge on the two-phase flow regime transition from bubbly to slug flows, it was postulated that bubble coalescence is intensified substantially when the local void fraction near the heated wall exceeds a critical value. It was discussed that this can be a main cause of a rapid increase in the cross-sectional area-averaged void faction since the condensation rate decreases suddenly due to a sudden decrease in the interfacial area of vapor bubbles. It was demonstrated that if the vaporization rate on the heat transfer surface is evaluated using a reliable wall heat transfer correlation, the OSV conditions calculated by the present model agree with those by a widely-used empirical correlation well.
AIM: To systematically evaluate the safety and efficacy of intravitreous injection of anti-VEGF drugs combined with Ahmed glaucoma drainage valve(AGV)implantation compared with single AGV ...implantation in the treatment of neovascular glaucoma(NVG).METHODS: PubMed, Cochrane Library, American Science Citation Index(SCI)Database, China National Knowledge Infrastructure(CNKI), Wanfang Database were searched from the establishment to July 20, 2021 for relevant literatures about the treatment of NVG with AGV implantation and anti-VEGF drugs. These literatures were imported into EndNoteX9, strictly screened according to the inclusion and exclusion criteria and evaluated for their quality, and the raw data were extracted and integrated. STATA 16.0 and RevMan 5.3 were applied for Meta-analysis.RESULTS: A total of 10 clinical studies with 490 eyes in total were included in Meta-analysis. According to the different research types of these literatures, the quality of the original literatures was evaluated as medium to high, and the homogeneity of the basic data among the studies was excellent. Meta-analysis showed that the intraocular pressure of patients who underwent intravitreous injection of anti-VEGF drugs was significantly decreased 1wk and 1mo after treatment compared with those patients who underwent single AGV implantation. Moreover, AGV implantation combined with intravitreous injection of anti-VEGF drugs could not improve postoperative best corrected visual acuity(BCVA). Although the combination with bevacizumab did not significantly improve the success rate of surgery, it could significantly reduce the amount of anti-glaucoma drugs still needed after surgery, whereas, ranibizumab did the opposite in both success rate and drug amount.CONCLUSION: Compared with single AGV implantation, the combination of AGV implantation and intravitreous injection of anti-VEGF drugs has advantages in reducing intraocular pressure of NVG patients. According to different anti-VEGF drugs, the combination has some positive effects on increasing the success rate of surgery and reducing the amount of anti-glaucoma drugs still needed after operation.
Purpose: To analyze cytokine profiles of the aqueous humor of eyes with primary open-angle glaucoma (POAG), neovascular glaucoma (NVG), and cataract (as controls).
Methods: A multiplex bead assay was ...used to measure concentrations of 27 cytokines in aqueous humor samples from 54 eyes.
Results: Detection rates were as follows: IL-7: NVG higher than POAG; IL-10: POAG lower than cataract or NVG; and GM-CSF: cataract higher than POAG or NVG. Concentrations were as follows: IL-8, IP-10, MCP-1, and MIP-1β: POAG and NVG higher than cataract; IL-9: POAG lower than NVG; IL-12: POAG lower than cataract or NVG; and VEGF: NVG higher than cataract or POAG and POAG lower than cataract. Further analysis showed that IL-8, IP-10, MCP-1, and MIP-1β were correlated with intraocular pressure and age.
Conclusions: The detection rates and levels of various cytokines had different patterns in POAG and NVG patients, suggesting distinctive alterations in the microenvironment in different types of glaucoma.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To compare 3-year outcomes and complications of the Ahmed FP7 Glaucoma Valve (AGV) (New World Medical, Cucamonga, CA) and the Baerveldt Glaucoma Implant (BGI) 101-350 (Abbott Medical Optics, Abbott ...Park, IL) for the treatment of refractory glaucoma.
Multicenter, randomized, controlled clinical trial.
A total of 276 patients: 143 in the AGV group and 133 in the BGI group.
Patients aged 18 to 85 years with refractory glaucoma and intraocular pressures (IOPs) ≥ 18 mmHg in whom an aqueous shunt was planned were randomized to an AGV or a BGI.
The IOP, visual acuity (VA), supplemental medical therapy, complications, and failure (IOP >21 mmHg or not reduced by 20% from baseline, IOP <5 mmHg, reoperation for glaucoma or removal of implant, or loss of light perception vision).
At 3 years, IOP (mean ± standard deviation) was 14.3 ± ± 4.7 mmHg (AGV group) and 13.1 ± 4.5 mmHg (BGI group) (P = 0.086) on 2.0 ± 1.4 and 1.5 ± 1.4 glaucoma medications, respectively (P = 0.020). The cumulative probabilities of failure were 31.3% (standard error SE, 4.0%) (AGV) and 32.3% (4.2%) (BGI) (P = 0.99). Postoperative complications associated with reoperation or vision loss of >2 Snellen lines occurred in 24 patients (22%) (AGV) and 38 patients (36%) (BGI) (P = 0.035). The mean change in the logarithm of the minimum angle of resolution VA at 3 years was similar (AGV: 0.21 ± 0.88, BGI: 0.26 ± 0.74) in the 2 treatment groups at 3 years (P = 0.66). The cumulative proportion of patients (SE) undergoing reoperation for glaucoma before the 3-year postoperative time point was 14.5% (3.0%) in the AGV group compared with 7.6% (2.4%) in the BGI group (P = 0.053, log rank). The relative risk of reoperation for glaucoma in the AGV group was 2.1 times that of the BGI group (95% confidence interval, 1.0-4.8; P = 0.045, Cox proportional hazards regression).
Implantation of the AGV was associated with the need for significantly greater adjunctive medication to achieve equal success relative to implantation of the BGI and resulted in a greater relative risk of reoperation for glaucoma. More subjects experienced serious postoperative complications in the BGI group than in the AGV group.
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