Professional Documents
Culture Documents
Art 3A10.1186 2Fs40942 016 0051 X
Art 3A10.1186 2Fs40942 016 0051 X
Abstract
Neovascular glaucoma (NVG) is a secondary glaucoma generally associated with poor visual prognosis. The devel
opment of new vessels over the iris and the iridocorneal angle can obstruct aqueous humor outflow and lead to
increased intraocular pressure. The underlying pathogenesis in most cases is posterior segment ischemia, which is
most commonly secondary to proliferative diabetic retinopathy or central vein retinal occlusion. The neovasculariza
tion process in the eye is driven by the events that alter the homeostatic balance between pro-angiogenic factors,
such as the vascular endothelial growth factor and anti-angiogenic factors, such as the pigment-epithelium-derived
factor. Early diagnosis of this condition through slit lamp examination of the iris, iridocorneal angle and retina can help
to avoid the development of goniosynechia and obstruction of aqueous humor outflow, with consequent intraocular
pressure elevation. Historically, NVG treatment was focused on reducing the posterior segment ischemic process that
caused the formation of new vessels, through panretinal photocoagulation. Recently, several studies have investi
gated the application of intravitreal anti-VEGF therapies in NVG. If clinical treatment with the use of hypotensive topi
cal drops is not sufficient, laser and/or surgical procedures are required for intraocular pressure control.
Keywords: Neovascular glaucoma, Refractory, Anti-VEGF, Diabetes, Central retinal vein occlusion
The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/
publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Rodrigues et al. Int J Retin Vitr (2016) 2:26 Page 2 of 10
On physical examination, a careful examination of iris Initially, the iridocorneal angle appears open on goni-
and anterior chamber angle is essential before pupil dila- oscopy but with the progression of the disease, neoves-
tion for fundus evaluation. Anterior biomicroscopy can sels can appear over the angle structures (Fig. 3). In the
reveal: rubeosis iridis (neovessels are vessels that do not final stages, peripheral anterior synechiae can occur and
follow an organized growth pattern, while iris vessels lead to complete angle closure (Fig.4) [4, 5]. The IOP may
usually grow radially symmetric), mild anterior chamber be normal in the early stages of the disease, but usually
reaction, corneal edema due to sharp increase of IOP, cil- goes to high levels in advanced stages of the disease when
iary injection and uveal ectropion by contraction of the the angle is closed by the contraction of the fibrovascular
fibrovascular membrane over the iris (Fig.1) [4, 5]. Rube- membrane. On fundus examination, glaucomatous optic
osis starts from the pupillary border with the appearance nerve damage may already be present depending on the
of tiny tufts of dilated capillaries (Fig.2) or red spots that duration of elevated IOP and its levels.
cant be seen unless the iris is examined under high mag- Despite the clinical diagnosis, in some cases, a func-
nification. Rubeosis iridis is usually present, though not tional test such as the electroretinography can be used
always, before neovascularization of the angle. In rare to differentiate between ischemic and non-ischemic
cases, there may be neovascularization of angle without forms of central retinal vein occlusion, helping to detect
neovascularization of the pupillary border, especially patients more prone to the development of neovasculari-
after ischemic central retinal vein occlusion. Therefore, it zation of the iris [5]. Both interocular amplitude differ-
is important to perform gonioscopy even when the bor- ence of 23 microV and interocular amplitude ratio of
der of the pupil is not involved. 60 % were good cutoff points to differentiate ischemic
from nonischemic central vein retinal occlusion [41]
Iris angiography can also be useful in some borderline
cases because it shows fluorescein leakage, which is not
normally seen [5]. Although these tools can aid in early
detection of neovascularization, they are expensive and
not always available. In contrast, gonioscopy is a widely
available e, fast and low cost procedure that can detect
neovascularization of the angle. Retinal angiography may
also help diagnosis elucidation, especially in cases of reti-
nal vascular disorders and it can also guide the treatment
with retinal photocoagulation. A Doppler ultrasound
may be necessary to identify carotid stenosis if obvious
retinal ischemia causes are not found [5].
optic nerve head circulation. Therefore surgical carotid addition there was a significant, though modest, best-
endarterectomy would be the best treatment in these corrected visual acuity improvement in intravitreal
cases [51]. ranibizumab injection group. They also had less post-
operative complications and lower failure ratio than
Vascular endothelial growth factor inhibitors Ahmed surgery. However, in a recent study conducted
Recently, use of anti-VEGF in the management of NVG by Olmos etal. [60] intravitreal injection of bevacizumab
has been extensively investigated [52]. Since 1996, sev- was not superior than panretinal photocoagulation. The
eral studies have been reporting VEGF as an important study was a retrospective, comparative, case series of
and predominant factor in the pathogenesis of neovascu- 163 eyes of 151 patients with NVG, including 99 treated
larization [9, 53]. VEGF inhibitors can stifle the neovas- without and 64 treated with intravitreal bevacizumab.
cularization process secondary to retinal ischemia [54]. Medical and surgical treatments for NVG were assessed.
The administration of anti-VEGF is currently becoming They found that IOP decreased to 18.3 13.8mmHg
established, supported by several studies suggesting bet- in the non-bevacizumab group and 15.3 8.0mmHg
ter visual prognosis and IOP control following anti-VEGF in the bevacizumab group. Panretinal photocoagula-
injections [6, 55]. tion substantially reduced the need for glaucoma sur-
Anti-VEGF injections can lead to regression of both iris gery (P < 0.001) in bevacizumab treated NVG eyes.
and angle neovascularization, and intraocular pressure Therefore, although bevacizumab delayed the need for
control when the angle remains open [56]. However, the glaucoma surgery, panretinal photocoagulation was the
effects of anti-VEGF agents seemed to induce only a tem- most important factor that reduced the need for surgery.
porary regression of new vessels in the anterior chamber Vision and IOP in eyes with NVG treated with bevaci-
angle as well as IOP reduction, generally during between zumab showed no long-term differences when compared
four to six weeks [6]. In the current review, we report with eyes that were not treated with bevacizumab. Thus,
some of the main results of some studies about use of intravitreal bevacizumab serves as an effective temporiz-
anti-VEGF in the treatment of NVG. ing treatment, but is not a replacement for close moni-
Yazdani etal. [57] investigated the effect of intravitreal toring and definitive treatment of NVG.
bevacizumab on NVG in a randomized controlled trial A systematic review by Simha et al. [61] found that
with 26 eyes from 26 patients. All eyes received conven- there is no evidence to evaluate statistically the effec-
tional treatment for NVG and were randomly allocated tiveness of anti-VEGF treatments, even as an adjunct
to three 2.5 mg intravitreal bevacizumab injections at to conventional treatment in reducing the IOP in NVG.
4-week intervals or a sham procedure. Authors concluded More recently, Tang et al. [62] performed a prospective
that intravitreal injections of bevacizumab reduced iris non-randomized study with 43 eyes of 43 neovascular
neovascularization and IOP in NVG and may be consid- glaucoma patients. In this study, patients were assigned
ered as an adjunct to more definitive surgical procedures to receive either 0.5mg intravitreal ranibizumab for three
for NVG. In addition, Wittstrom et al. investigated the to 14days before a Ahmed glaucoma valve implantation
effect of a single intravitreal injection of bevacizumab for (n = 21) or Ahmed glaucoma valve implantation alone
NVG after ischemic central retinal vein occlusion [58]. In (n=22). They found a success rate of 73.7 vs. 71.4% at
this study 19 eyes from 19 patients were randomly allo- 6months and 72.2 vs. 68.4% at 12months in the injec-
cated to either an intravitreal bevacizumab injection and tion group and the control group, respectively. There
panretinal photocoagulation (10 eyes) or panretinal pho- were no significant differences in the two groups with
tocoagulation alone (9 eyes). Their results suggested that respect to intraocular pressure, best corrected visual acu-
intravitreal injection of bevacizumab might be valuable ity, anti-glaucoma medications or postoperative compli-
in the treatment of NVG by improving the resolution of cations at 6 or 12months. They concluded, therefore that
neovascularization. a single intravitreal ranibizumab before surgery has no
Liu et al. [59] investigated the efficacy and safety of significant effect on the medium- or long-term outcomes
intravitreal ranibizumab injection combined with trab- of neovascular glaucoma treated with Ahmed glaucoma
eculectomy compared it with Ahmed valve surgeries. In valve implantation.
this prospective study, they have included 37 eyes from Sahyoun etal. [63] also evaluated the long-term results
36 NVG patients, in which 18 NVG eyes were given of the Ahmed glaucoma valve implantation in association
intravitreal ranibizumab injection one week before tra- with bevacizumab in NVG patients in a retrospective
beculectomy. Ahmed valve implantation surgery was study.
performed in 19 eyes. Their results showed that IOP was Their study included 39 eyes of 34 patients, which
significantly decreased following intravitreal ranibizumab were divided in two groups. The first group consisted
injection combined with trabeculectomy treatment. In of 19 eyes that received an injection of intravitreal
Rodrigues et al. Int J Retin Vitr (2016) 2:26 Page 6 of 10
bevacizumab 7 days preoperatively, whereas the sec- formation and angle closure have occurred. Surgical
ond group without the injection, included 20 eyes. Even interventions for NVG include: trabeculectomy with anti-
though, preoperative intravitreal bevacizumab before metabolites, glaucoma drainage devices, cyclophoto-
Ahmed glaucoma valve surgery was not associated with coagulation, among others. NVG is a refractory type of
a better surgical success, IOP control, or best-corrected glaucoma that poses a challenge for proper IOP control
visual acuity. Its administration significantly decreased and is often associated with increased risk for postopera-
postoperative hyphema and number of last visits tive complications including hyphema and vision loss.
antiglaucoma medications.
Zhou etal. [64] conducted a systematic review to eval- Trabeculectomy
uate the efficacy and tolerability of Ahmed glaucoma NVG has been associated with high rates of failure after
valve implantation with intravitreal bevacizumab injec- trabeculectomy [67, 68] but the adjunct use of antimetab-
tion pretreatment in the treatment of NVG. olites has improved the success rate of the surgery [69].
They found that the intravitreal bevacizumab group Sisto et al. [69] showed 55 % of success rate in a mean
was associated with significant greater complete success follow-up of 35 months with the use of postoperative
rates compared with the control group. However, it did 5-fluorouracil and 54% of success rate in a mean follow-
not show a significant difference for the qualified success up 18 months with intraoperative mitomycin C. Still,
rate between them. In addition, the intravitreal bevaci- compared to other types of glaucoma, NVG is a known
zumab group was associated with a significantly lower risk factor for surgical failure [70]. Moreover, it has been
frequency of hyphema than the control group. suggested that a postoperative hyphema, a common
More recently, newer anti-VEGF agents such as afliber- complication in patients with NVG, may be associated
cept have also been used in the treatment of NVG [65]. with higher rates of trabeculectomy failure in NVG [71].
Soohoo et al. reported a case series study with 4 newly
diagnosed stage 1 or 2 NVG patients. They were treated Glaucoma drainage devices
with intravitreal aflibercept at the time of diagnosis, and Glaucoma drainage devices are usually considered the
repeated injections at 4, 8 and then every 8weeks there- first treatment option for refractory glaucoma. However,
after up until 52weeks after study initiation. They found NVG patients are at greater risk for surgical failure after
that intravitreal aflibercept resulted in rapid regression Ahmed glaucoma valve surgery compared with con-
of iris and angle neovascularization. IOP was stable or trols. Yalvac reported 63.2 and 56.2% of success rates at
reduced in all patients at the 52-week study visit, sug- 1 and 2years after Ahmed glaucoma valve implantation,
gesting that intravitreal aflibercept may be an effective respectively [72]. Hernandez-Oteyza recently reported a
treatment for stage 1 and 2 NVG, even though further success rate of 60% at 1year of follow-up and found that
research is needed to determine the full duration of effect a hypertensive phase in the postoperative period and a
and the optimal dose and timing of administration. worse preoperative BCVA to be risk factors for Ahmed
In conclusion, there still a debate about the real effec- valve surgical failure in patients with NVG [73]. Net-
tiveness of anti-VEGF in the management of NVG. There land et al. found that the success rate was significantly
is evidence showing that a pre-treatment with anti-VEGF lower over time in eyes with NVG compared with con-
before definitive IOP lowering glaucoma surgeries can trols. They reported success rates at 5years of 81.8% for
significantly lower the frequency of hyphema. But further control and 20.6 % for patients with NVG [74]. Similar
research is still needed to evaluate the impact on long- results have been reported with other types of glaucoma
term IOP control, visual acuity and cost-effectiveness of drainage devices [7578]. Furthermore, there is no evi-
the anti-VEGF injections in the management of NVG. It dence of improved surgical outcomes with glaucoma
is also important to remember that continuous intravit- drainage devices as opposed to augmented trabeculec-
real anti-VEGF injections may cause both transient and tomy. Similar results have been reported when treat-
sustained elevation in IOP [66]. ment with Ahmed Glaucoma valve was compared to
trabeculectomy with mitomycin C. Shen et al. reported
Surgical treatment success rates of 70 and 65% at 1year and 60 and 55% at
Although the mainstay of therapy of NVG is the treat- 2years after Ahmed glaucoma valve and trabeculectomy
ment of retinal ischemia with panretinal photocoagu- with mitomycin C, respectively [79]. Therefore, proper
lation, surgical interventions to control IOP are often control of retinal neovascularization in addition to either
necessary since the use of eye-drops may not lower trabeculectomy with mitomycin C or glaucoma drainage
IOP enough to prevent optic nerve damage. Especially device implantation seem appropriate treatment options
in those cases in which peripheral anterior synechia for IOP control in NVG patients.
Rodrigues et al. Int J Retin Vitr (2016) 2:26 Page 7 of 10
A randomized clinical trial by Arcieri et al. investi- [89] However, prospective and comparative studies with
gated the efficacy and safety of intravitreal bevacizumab longer follow-up are still needed.
in eyes with NVG undergoing Ahmed glaucoma valve
implantation. They enrolled 40 patients who were ran- Cyclodestructive procedures
domized to receive intravitreal bevacizumab (1.25 mg) Transcleral application of diode laser cyclophotoco-
or not during Ahmed valve implant surgery. Injections agulation consists of the destruction the ciliary body
were administered intra-operatively, 4 and 8weeks after epithelium and stroma with consequent reduction of
surgery. Their results suggest a trend that using with aqueous humor production and IOP levels [9092].
intravitreal bevacizumab as an adjunct can lower IOP Transcleral cyclophotocoagulation with and without
levels and the number of post operative medications in the use anti-VEGF has been shown to be effective in
NVG patients who underwent Ahmed glaucoma valve lowering IOP and relieving pain in advanced cases of
implantation. It is important to note, however, that NVG [70, 9395]. When compared to Ahmed valve
patients with NVG are at a higher risk for certain post- implantation in a randomized controlled trial, no sig-
operative complications and poor visual outcomes, pos- nificant difference was found in the success rate at
sibly due to progression of underlying disease. Loss of 24 months between the diode cyclophotocoagulation
light perception is not rare among NVG patients after (61.18 %) and Ahmed glaucoma valve implantation
surgical procedures [74, 75, 77] and hyphema is often (59.26 %) in NVG treatment [91]. It is important to
encountered [80]. Compared to other types of glau- note, however, that the underlying diagnosis of NVG
coma, NVG eyes also seem to be at higher risk for tube poses an increased risk for hypotony after transcleral-
shunt exposure [81]. cyclophotocoagulation [9497]. Endo-cyclophotoco-
Since NVG and proliferative diabetic retinopathy are agulation was also shown to be effective in NVG. A
usually co-existing conditions, it is not uncommon for study showed success rates at 24 months of 70.59 and
patients with NVG to have a positive history of prior vit- 73.53 % for the Ahmed and endo-cyclophotocoagula-
rectomy. Studies that evaluated implantation of Ahmed tion groups, respectively [98].
glaucoma valve for IOP control in vitrectomized eyes,
showed the safety and efficacy of the procedure [82, Other surgical options
83], with success rates of 62.5% after 3years for vitrec- Due to the relatively low long-term success rates of
tomized eyes, which was not statistically different from the existing treatment options for NVG, new surgical
the 68.5 % success rate for the nonvitrectomized group. approaches have been proposed for IOP control. For
Ahmed glaucoma valve can control the IOP in the major- example, manual and bimanual maneuvers to remove the
ity of eyes after pars plana vitrectomy and silicone oil fibrovascular membrane from the anterior chamber angle
injection, when implanted in the anterior chamber or have been described [99]. The use of drainage devices
inferonasal or inferotemporal quadrant, preventing oil to made of porous material such as the Ahmed M4 [100]
clogging the tube. [84]. If this surgery is selected, intra- and the Express shunt [101] has also been attempted.
silicone injection of anti-VEGF in posterior segment for However, more studies and randomized clinical trials are
regressing iris neovascularization is considered safe and needed to assess the efficacy of such procedures.
effective [85]. However, intraocular silicone oil tam-
ponade was found to be a risk factor for surgical failure Conclusion
[83]. The combination of 23-gauge pars plana vitrectomy NVG is an important secondary glaucoma associated
and Ahmed valve implantation in the same procedure with poor visual prognosis, due to the optic nerve dam-
is also a treatment option for these cases and has been age from high IOP and also complications from retinal
shown to be safe and effective in patients with prolifera- vascular diseases. Even though treatment options with
tive diabetic retinopathy and refractory NVG [86, 87]. panretinal photocoagulation and anti-VEGF might be
Wallsh etal. confirmed these findings in a retrospective used in attempt to control the neovascularization pro-
study with a 22 patients, in which 95.8% of eyes had IOP cess, in some cases surgical procedures are necessary in
below 21 mmHg in the final follow-up (mean follow-up order to achieve normal levels of IOP and avoid optic
of 7.391.11months). Best-corrected visual acuity also nerve damage. Proper management and early diagnosis
improved significantly [88]. Finally, a retrospective study of this condition is crucial to reduce the chances of visual
evaluated the results of combined pars plana vitrectomy impairment.
and pars plana Baerveldt tube placement. A significant
IOP decrease was achieved with the procedure while
Abbreviations
visual acuity remained unchanged. However, it is impor- NVG: Neovascular glaucoma; IOP: Intraocular pressure; VEGF: Vascular
tant to note that 38 % experienced a decrease in vision endothelial growth factor.
Rodrigues et al. Int J Retin Vitr (2016) 2:26 Page 8 of 10
46. Centofanti M, etal. Comparative effects of intraocular pressure 72. Yalvac IS, etal. Long-term results of Ahmed glaucoma valve
between systemic and topical carbonic anhydrase inhibitors: a clinical and Molteno implant in neovascular glaucoma. Eye (Lond).
masked, cross-over study. Pharmacol Res. 1997;35(5):4815. 2007;21(1):6570.
47. Kasbe AS, Patankar SM. Acetyl salicylic acid induced hyphema during 73. Hernandez-Oteyza A, Lazcano-Gomez G, Jimenez Roman J, Hernan
cataract surgerya case report. Med Sci. 2015;4(2):434. dez- Garciadiego C. Surgical outcome of ahmed valve implantation in
48. Lang GE. Laser treatment of diabetic retinopathy. Dev Ophthalmol. mexican patients with neovascular glaucoma. J Curr Glaucoma Pract.
2007;39:4868. 2014;8(3):8690.
49. Natural history and clinical management of central retinal vein 74. Netland PA, Ishida K, Boyle JW. The Ahmed Glaucoma Valve in patients
occlusion. The Central Vein Occlusion Study Group. Arch Ophthalmol. with and without neovascular glaucoma. J Glaucoma. 2010;19(9):5816.
1997;115(4):48691. 75. Every SG, etal. Long-term results of Molteno implant insertion in cases
50. Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome. Oph of neovascular glaucoma. Arch Ophthalmol. 2006;124(3):35560.
thalmology. 1997;104(5):85964. 76. Krupin T, etal. Long-term results of valve implants in filtering surgery for
51. Brown GC. Anterior ischemic optic neuropathy occurring in asso eyes with neovascular glaucoma. Am J Ophthalmol. 1983;95(6):77582.
ciation with carotid artery obstruction. J Clin Neuroophthalmol. 77. Sidoti PA, etal. Experience with the Baerveldt glaucoma implant in
1986;6(1):3942. treating neovascular glaucoma. Ophthalmology. 1995;102(7):110718.
52. Olmos LC, Lee RK. Medical and surgical treatment of neovascular glau 78. WuDunn D, etal. Clinical experience with the Baerveldt 250-mm2
coma. Int Ophthalmol Clin. 2011;51(3):2736. glaucoma implant. Ophthalmology. 2006;113(5):76672.
53. Peer J, etal. Upregulated expression of vascular endothelial 79. Shen CC, etal. Trabeculectomy versus Ahmed Glaucoma Valve implan
growth factor in proliferative diabetic retinopathy. Br J Ophthalmol. tation in neovascular glaucoma. Clin Ophthalmol. 2011;5:2816.
1996;80(3):2415. 80. Kojima S, etal. Risk factors for hyphema after trabeculectomy with
54. Park SC, Su D, Tello C. Anti-VEGF therapy for the treatment of glaucoma: mitomycin C. J Glaucoma. 2014;23(5):30711.
a focus on ranibizumab and bevacizumab. Expert Opin Biol Ther. 81. Koval MS, etal. Risk factors for tube shunt exposure: a matched case-
2012;12(12):16417. control study. J Ophthalmol. 2013;2013:196215.
55. SooHoo JR, Seibold LK, Kahook MY. Recent advances in the manage 82. Cheng Y, etal. Ahmed valve implantation for neovascular glaucoma
ment of neovascular glaucoma. Semin Ophthalmol. 2013;28(3):16572. after 23-gauge vitrectomy in eyes with proliferative diabetic retinopa
56. Horsley MB, Kahook MY. Anti-VEGF therapy for glaucoma. Curr Opin thy. Int J Ophthalmol. 2013;6(3):31620.
Opthal. 2010;21(2):1127. 83. Park UC, etal. Ahmed glaucoma valve implantation for neovascular
57. Yazdani S, etal. Intravitreal bevacizumab for neovascular glaucoma: a glaucoma after vitrectomy for proliferative diabetic retinopathy. J
randomized controlled trial. J Glaucoma. 2009;18(8):6327. Glaucoma. 2011;20(7):4338.
58. Wittstrom E, etal. Clinical and electrophysiologic outcome in patients 84. Ishida K, Ahmed IK, Netland PA. Glaucoma valve surgical outcomes
with neovascular glaucoma treated with and without bevacizumab. Eur in eyes with and without silicone oil endotamponade. J Glaucoma.
J Ophthalmol. 2012;22(4):56374. 2009;18:32530.
59. Liu L, Xu Y, Huang Z, Wang X. Intravitreal ranibizumab injection com 85. Salman AG. Intrasilicone bevacizumab injection for iris neovasculariza
bined trabeculectomy versus Ahmed valve surgery in the treatment of tion after vitrectomy for proliferative diabetic retinopathy. Ophthalmic
neovascular glaucoma: assessment of efficacy and complications. BMC Res. 2013;49(1):204.
Ophthalmol. 2016;16:65. 86. Faghihi H, etal. Pars plana Ahmed valve implant and vitrectomy in the
60. Olmos LC, Sayed MS, Moraczewski AL, etal. Long-term outcomes of management of neovascular glaucoma. Ophthalmic Surg Lasers Imag
neovascular glaucoma treated with and without intravitreal bevaci ing. 2007;38(4):292300.
zumab. Eye (Lond). 2016;30(3):46372. 87. Jeong HS, etal. Pars plana Ahmed implantation combined with
61. Simha A, etal. Anti-vascular endothelial growth factor for neovascular 23-gauge vitrectomy for refractory neovascular glaucoma in diabetic
glaucoma. Cochrane Database Syst Rev. 2013, 10:Cd007920. retinopathy. Korean J Ophthalmol. 2012;26(2):926.
62. Tang M, Fu Y, Wang Y, etal. Efficacy of intravitreal ranibizumab com 88. Wallsh JO, etal. Pars plana Ahmed valve and vitrectomy in patients
bined with Ahmed glaucoma valve implantation for the treatment of with glaucoma associated with posterior segment disease. Retina.
neovascular glaucoma. BMC Ophthalmol. 2016;16:7. 2013;33(10):205968.
63. Sahyoun M, Azar G, Khoueir Z, etal. Long-term results of Ahmed glau 89. Kolomeyer AM, Seery CW, Emami-Naemi P, Zarbin MA, Fechtner RD,
coma valve in association with intravitreal bevacizumab in neovascular Bhagat N. Combined pars plana vitrectomy and pars plana Bae
glaucoma. J Glaucoma. 2015;24(5):3838. rveldt tube placement in eyes with neovascular glaucoma. Retina.
64. Zhou M, Xu X, Zhang X, Sun X. Clinical outcomes of ahmed glaucoma 2015;35(1):1728.
valve implantation with or without intravitreal bevacizumab pretreat 90. Bloom PA, etal. Cyclodiode. Trans-scleral diode laser cyclophotocoagu
ment for neovascular glaucoma: a systematic review and meta-analysis. lation in the treatment of advanced refractory glaucoma. Ophthalmol
J Glaucoma. 2016;25(7):5517. ogy. 1997;104(9):150819 (discussion 1519-20).
65. SooHoo JR, Seibold LK, Pantcheva MB, Kahook MY. Aflibercept for the treat 91. Feldman RM, etal. Histopathologic findings following contact trans
ment of neovascular glaucoma. Clin Exp Ophthalmol. 2015;43(9):8037. scleral semiconductor diode laser cyclophotocoagulation in a human
66. SooHoo JR, Seibold LK, Kahook MY. The link between intravitreal anti eye. J Glaucoma. 1997;6(2):13940.
vascular endothelial growth factor injections and glaucoma. Curr Opin 92. Schlote T, etal. Efficacy and safety of contact transscleral diode
Ophthalmol. 2014;25(2):12733. laser cyclophotocoagulation for advanced glaucoma. J Glaucoma.
67. Allen RC, etal. Filtration surgery in the treatment of neovascular glau 2001;10(4):294301.
coma. Ophthalmology. 1982;89(10):11817. 93. Ghosh S, etal. Combined diode laser cyclophotocoagulation and
68. Mietz H, Raschka B, Krieglstein GK. Risk factors for failures of trab intravitreal bevacizumab (Avastin) in neovascular glaucoma. Clin Exp
eculectomies performed without antimetabolites. Br J Ophthalmol. Ophthalmol. 2010;38(4):3537.
1999;83(7):81421. 94. Iliev ME, Gerber S. Long-term outcome of trans-scleral diode laser
69. Sisto D, etal. The role of antimetabolites in filtration surgery for neovas cyclophotocoagulation in refractory glaucoma. Br J Ophthalmol.
cular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand. 2007;91(12):16315.
2007;85(3):26771. 95. Murphy CC, etal. A two centre study of the dose-response relation for
70. Tsai JC, etal. Combined transscleral diode laser cyclophotocoagulation transscleral diode laser cyclophotocoagulation in refractory glaucoma.
and transscleral retinal photocoagulation for refractory neovascular Br J Ophthalmol. 2003;87(10):12527.
glaucoma. Retina. 1996;16(2):1646. 96. Yildirim N, etal. A comparative study between diode laser cyclopho
71. Nakatake S, Yoshida S, Nakao S, Arita R, Yasuda M, Kita T, Enaida H, tocoagulation and the Ahmed glaucoma valve implant in neovascular
Ohshima Y, Ishibashi T. Hyphema is a risk factor for failure of trabeculec glaucoma: a long-term follow-up. J Glaucoma. 2009;18(3):1926.
tomy in neovascular glaucoma: a retrospective analysis. BMC Ophthal 97. Ramli N, etal. Risk factors for hypotony after transscleral diode cyclo
mol. 2014;26:1455. photocoagulation. J Glaucoma. 2012;21(3):16973.
Rodrigues et al. Int J Retin Vitr (2016) 2:26 Page 10 of 10
98. Lima FE, etal. A prospective, comparative study between endoscopic 101. Guven YS, Yildirim S, Degirmenci C, Ates H. Evaluation of Ex-PRESS
cyclophotocoagulation and the Ahmed drainage implant in refractory mini glaucoma shunt implantation with preoperative intracameral
glaucoma. J Glaucoma. 2004;13(3):2337. bevacizumab injection in refractory neovascular glaucoma. 2016. [Epub
99. Nadal J, etal. Neovascular glaucoma treatment with extrac ahead of print].
tion of anterior chamber fibrovascular tissue. JAMA Ophthalmol.
2013;131(8):10835.
100. Gil-Carrasco F, Jimnez-Romn J, Turati-Acosta M, Bello-Lpez Portillo
H, Isida Llerandi CG. Comparative study of the safety and efficacy of the
Ahmed glaucoma valve model M4 (high density porous polyethylene)
and the model S2 (polypropylene) in patients with neovascular glau
coma. Arch Soc Esp Oftalmol. 2016;994:16.