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

Authors Sakamoto M, Hashimoto R, Yoshida I, Ubuka M, Maeno T

Received 23 August 2018

Accepted for publication 16 October 2018

Published 14 November 2018 Volume 2018:12 Pages 2323—2329


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Masashi Sakamoto, Ryuya Hashimoto, Izumi Yoshida, Makoto Ubuka, Takatoshi Maeno

Department of Ophthalmology, Toho University Sakura Medical Center, Shimoshizu, Sakura, Japan

Purpose: To investigate the potential risk factors for neovascular glaucoma (NVG) after vitrectomy in eyes with proliferative diabetic retinopathy.
Subjects and methods: In this retrospective, observational, comparative study, patients with proliferative diabetic retinopathy who underwent vitrectomy at Toho University Sakura Medical Center between December 2011 and November 2016 and who were followed for ≥12 months after surgery were included. Subject parameters examined included age, glycated hemoglobin (HbA1c), fasting blood glucose, administration of insulin, and estimated glomerular filtration rate. Ocular parameters examined included preoperative best-corrected visual acuity, preoperative IOP, operative history (specifically panretinal photocoagulation), lens status, ocular pathology (eg, iris/angle neovascularization, tractional retinal detachment, diabetic macular edema, vitreous hemorrhage, combined tractional retinal detachment), intraoperative retinal tamponade use, vitrectomy gauge, combined lens extraction/vitrectomy procedure, subsequent surgical procedures, and pre- and postoperative intravitreal bevacizumab. Correlations between variables and postoperative NVG development were examined using logistic regression analyses (backward elimination method).
Results: A total of 254 eyes of 196 consecutive subjects (146 men [74.5%], 54.0±10.8 years old) were included. Sixty of 254 eyes (23.6%) developed NVG. Several preoperative factors increased the risk of developing NVG, including iris/angle neovascularization (P=0.042), preoperative high IOP (P=0.005), low HbA1c (P=0.004), and administration of insulin (P=0.045). Intraoperative retinal tamponade also increased NVG risk (P=0.021, backward elimination method).
Conclusion: Preoperative parameters such as elevated IOP, iris/angle neovascularization, fasting blood sugar and HbA1c discrepancies, administration of insulin, as well as use of retinal tamponade during retinal surgery were identified as the risk factors for developing NVG.

Keywords: neovascular glaucoma, proliferative diabetic retinopathy, vitrectomy

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