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Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 1-7

Management of stage IV neovascular glaucoma in proliferative diabetic retinopathy with single step pars plana vitrectomy + endolaser + trabeculectomy + mitomycin C versus 2-step approach, i.e., pan retinal photocoagulation followed by trabeculectomy + mitomycin C

1 VItreo Retinal Surgeon, Sarakshi Netralaya, Nagpur, Maharashtra, India
2 Statistician MDS Bio-Analytics Pvt Ltd, Nagpur, Maharashtra, India
3 DNB 2nd Year, Sarakshi Netralaya, Nagpur, Maharashtra, India
4 Glaucoma Specialist, Sarakshi Netralaya, Nagpur, Maharashtra, India

Correspondence Address:
Dr. Shilpi Narnaware
Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur - 440 025 Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/erj.erj_9_21

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Purpose: To compare the success between single-step pars plana vitrectomy (PPV) + Endolaser (EL) + Trabeculectomy + mitomycin C (MMC) and 2-step approach, i.e., pan-retinal photocoagulation (PRP) followed by Trabeculectomy + MMC in cases of stage IV neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR). Methods: Prospective, interventional study including 16 eyes of 16 patients with stage 4 NVG in cases of PDR between July 2019 and December 2020. Depending on the type of surgery, patients were divided into two groups. Group I: PRP followed by Trabeculectomy + MMC (n = 8), Group II: Combined PPV + EL + Trabeculectomy + MMC (n = 8). All patients received intravitreal bevacizumab 3 days before the surgery in both groups. Success criteria were postoperative intraocular pressure (IOP) of <20 mm Hg with or without antiglaucoma medication. Results: Postoperative IOP decreased significantly in both groups, but the mean IOP after 6 months was lower in combined group (17 mm Hg) than trabeculectomy group (22.25 mm Hg; P = 0.204). Combined group required fewer anti-glaucoma medications (mean: 0.88) than trabeculectomy group (mean: 1.38). Cumulative surgical success rates for combined group and Trabeculectomy groups were 100% and 75% respectively. No significant differences in intraoperative complications were observed between the groups. Conclusion: In stage 4, NVG secondary to PDR, single step combined approach including PPV + EL + Trabeculectomy + MMC could be more effective in controlling IOP with better visual outcome than Trabeculectomy + MMC.

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