Full preoperative panretinal photocoagulation improves the outcome of trabeculectomy with mitomycin C for neovascular glaucoma.

PURPOSE. To investigate the efficacy of full panretinal photocoagulation (PRP) followed by trabeculectomy with mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS. This study is based on 30 consecutive eyes of 27 patients with NVG who underwent full PRP followed by trabeculectomy with MMC. NVG was secondary to proliferative diabetic retinopathy (23 eyes) and central retinal vein occlusion (7 eyes). Kaplan-Meier survival analysis of the surgical outcome was performed. Operative success was defined as an intraocular pressure (IOP) of ≤ 21 mmHg without medical therapy. RESULTS. Kaplan-Meier cumulative success rates at the 6-, 12-, and 24-month intervals were 86.5%, 74.7%, and 57.6%, respectively. Pseudophakia was the only identified significant risk factor for failure (p=0.0138; Fisher exact test). Additional surgical procedures were performed in 8 (26.6%) eyes. The mean IOP decreased from 41.0±10.2 mmHg to 18.2±9.2 mmHg (p<0.001; Wilcoxon signed rank test). The number of anti-glaucoma medications was reduced from 3.1±0.5 preoperatively to 0.3±0.7 postoperatively (p<0.001; Wilcoxon signed rank test). Twenty-four (80%) eyes were classified as surgical success after a mean followup period of 17.3±22.1 months. Twenty-two (73.3%) eyes had improved vision or retained preoperative vision. CONCLUSIONS. Full PRP followed by trabeculectomy with MMC can effectively reduce the elevated IOP associated with NVG. Presence of pseudophakia is a significant negative predictor of surgical outcome. (Eur J Ophthalmol 2008; 18: 758-64)