Combined method of treatment of secondary neovascular glaucoma in hospital

SummaryBackground and aim of the study. The results of the combined method oftreatment of neovascular glaucoma in pensioners of the Ministry of Defense of Ukrainein National Military Clinical Medical Center «Main Military Clinical Hospital» wereanalyzed to evaluate the effectiveness of surgery and gradual reduction of intraocularpressure on the background of drug therapy in an inpatient setting.Materials and methods. The study, which has been conducted for more than 3years, included 20 people (21 eyes) of the main group with neovascular glaucoma agedfrom 48 to 78 years, which was caused by thrombosis of the central vein of the retina orits branches (15 cases), and diabetes (6 cases). Visual acuity varied from the correctlight projection to 0.08. Intraocular pressure on the drug therapy (β-blocker andcarbonic anhydrase inhibitor) ranged from 28 to 45 mm Hg. Rubeosis of the iris stage Iaccording to the classification of Wand (single newly formed vessels along the pupillaryedge) was observed in 6 eyes, stage II (newly formed vessels in all areas of the iris) – in10 eyes, stage III – (newly formed vessels in all areas of the iris and single – in thecorner of the anterior chamber) – in 5 eyes. A circular incision of the conjunctiva alongthe limbus was performed under local anesthesia. With the help of cryoapplicator 5–8coagulates were applied in each of the four quadrants (exposure time – 5–8 s) in theprojection of the retina in 10–15 mm from the limbus and 2–3 coagulates on theprojection area of the ciliary body 2 mm from the limbus (action time – 60 s). Then, as arule, in a projection of 12 hours fistulizing intervention was performed according to themethod. The control group included 20 patients (20 eyes) with neovascular hematoma,who underwent cryopexy of the retina and ciliary body without fistulizing intervention.Results. It was found that only combined treatment which involves a combination ofsurgery (fistulizing surgery and cryopexy of the retina and ciliary body) is a safe andeffective procedure in patients with secondary neovascular glaucoma and stage I–IIIrubeosis, which allows to improve the quality of life and stabilize vision for a longperiod.Conclusions. The study shows high efficiency of the combined method of treatmentof neovascular hematoma in pensioners of the Ministry of Defense of Ukraine inNational Military Clinical Medical Center «Main Military Clinical Hospital», whichincludes surgery and gradual reduction of intraocular pressure on the background ofdrug therapy, which improves and stabilizes visual function. The effectiveness of thismethod of treatment is maintained for at least 6–12 months after surgery, furtherreduction of visual acuity is possible due to the progression of glaucoma.