Microsecond Pulse Cyclophotocoagulation And Anti-Vegf Injections In The Treatment Of Neovascular Glaucoma
Published 2024 - 42nd Congress of the ESCRS
Reference: PO1051 | Type: Free paper | DOI: 10.82333/5mhe-az81
Authors: Natalia Palarie* 1 , Natalia Palii 2
1Depatment of Ophthalmology,International Clinic,Orhei,Moldova, Republic of;Department of Biochemistry,Nicolae Testemitanu State University of Medicine and Pharmacy,Chisinau,Moldova, Republic of, 2Depatment of Ophthalmology,International Clinic,Orhei,Moldova, Republic of
Purpose
Neovascular glaucoma (NVG) is among the most difficult to manage and prognostically unfavorable types of glaucoma. This study aimed to evaluate the efficacy of a combined therapeutic strategy, incorporating intraocular administration of a VEGF inhibitor and microsecond pulse cyclophotocoagulation (µCPC), in treating secondary neovascular glaucoma.
Setting
Study was performed at the Ophthalmology Department of International Clinic in Orhei, Moldova in February - December 2023.
Methods
The study encompassed 58 patients (67 eyes) with secondary neovascular glaucoma attributable to diabetes and/or thrombosis of the central retinal vein or its branches. Best corrected visual acuity (BCVA) ranged from hand motion to 0.4; the mean intraocular pressure (IOP) prior to the procedure was 42 ± 12 mm Hg. Participants received an intraocular injection of a VEGF inhibitor (Bevacizumab), followed within 5-7 days by application of an 810 nm infrared diode laser in microsecond pulse mode at 2000 mW, totaling an exposure time of 220-240 seconds (equivalent to 145 – 160 J) and a duty cycle of 33.3%. Follow-ups were conducted at baseline, and at weeks 1, and months 1, 3, and 6 post-procedure.
Results
An average of 1.3 treatments were administered per eye, with 20 eyes (30%) requiring retreatment by continuous-wave CPC within the first month. Success was defined as a reduction in the number of anti-glaucoma drops (AGD) and an IOP of 11-21 mm Hg at the last follow-up visit. Mean IOP decreased to 28.5 ± 5.0 mm Hg at 1 week, 23.0 ± 5.3 mm Hg at 1 month, 19.5 ± 3.2 mm Hg at 3 months, and 18.5 ± 2.5 mm Hg at 6 months. A stable reduction in IOP was observed only after three months. The overall success rate was 74%. AGD usage decreased from an average of 2.0 ± 1.0 at baseline to 1.1 ± 1.2 at 1 month, increased to 1.7 ± 1.0 at 3 months, and further to 2.2 ± 1.2 by 6 months of follow-up. No hypotony or other complications were reported.
Conclusions
This study supports the combination of VEGF inhibitor injection and µCPC as an effective, safe, and rapid treatment method for patients with NVG over a 6-month period.