Intravitreal conbercept with photocoagulation and phacoemulsifcation in Neovascular glaucoma effectively reduces IOP
Neovascular glaucoma (NVG) is a complex refractory glaucoma with a high rate of blindness. The disease mostly occurs in people over 40 years of age, so timely and reliable measures should be given to avoid vision loss. The main causes are ocular ischemic syndrome, fundus retinal vein occlusion, diabetic retinopathy, and other ocular ischemic diseases. Clinical manifestations are difficult to control high intraocular pressure, irreversible visual impairment, and intractable eye pain, often complicated by a variety of eye diseases, such as cataracts, corneal degeneration, and so on. At present, for NVG patients with cataracts, trabeculectomy, goniosynechialysis combined with phacoemulsification, and intraocular lens implantation are mainly performed to reduce intraocular pressure and restore vision.
This study by Xue Li and Dawei Zhang investigated the effect of intravitreal injection of conbercept combined with minimally invasive photocoagulation and phacoemulsification, and intraocular lens implantation in the treatment of NVG patients with cataracts.
A total of 84 patients with NVG complicated with cataracts who were admitted to hospital from September 2019 to September 2021 were selected. According to the random number table method, they were divided into the study group and the control group, with 42 cases in each. The control group underwent minimally invasive photocoagulation combined with phacoemulsification and intraocular lens implantation. The study group was given an intravitreal injection of conbercept first, followed by minimally invasive photocoagulation combined with phacoemulsification and intraocular lens implantation 3 to 7 days after the injection. The intraocular pressure and visual acuity of the two groups before surgery, 1 week, 1 month, 3 months, and 6 months after the operation were compared. The levels of serum vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) were compared between the two groups before the operation and 1 week after the operation. The incidence of postoperative complications in the two groups was statistically compared
At 1 week, 1 month, 3 months, and 6 months after the operation, the intraocular pressure of the study group was lower than that of the control group, and the visual acuity was better than that of the control group (P < 0.05); one week after the operation, the serum levels of VEGF and IL-6 in the study group were lower than those in the control group (P < 0.05); there was no significant difference in the incidence of complications between the two groups (P > 0.05).
The pathogenesis of NVG is complex and is related to retinal ischemic disease. When the retina has hypoxia-ischemia, the eye VEGF will be oversecreted and circulate to the chamber angle and anterior chamber through the aqueous humor, resulting in the formation of neovascularization and a fibrous membrane, which will further pull the chamber angle and close its adhesion, resulting in the increase of intraocular pressure (IOP). High intraocular pressure will aggravate the degree of retinal ischemia, form a vicious circle, and damage vision. Therefore, the key to NVG treatment is to inhibit neovascularization and reduce intraocular pressure.
The results of this study showed that the IOP of the study group was lower than that of the control group at 1 week, 1 month, 3 months, and 6 months after the operation. The reason is that with the help of the anti-VEGF drug Compaq, IOP can be quickly and effectively controlled within the normal range after NVG. The visual acuity of 6 months after the operation was better than that of the control group, indicating that intravitreal injection of the conbercept combined with minimally invasive photocoagulation, and phacoemulsification and intraocular lens implantation in the treatment of NVG with cataract has a significant curative effect in reducing intraocular pressure and improving visual acuity. IL-6 can mediate the body’s inflammatory response and can also regulate VEGF expression in vivo.
This study found that the serum VEGF and IL-6 levels decreased one week after surgery, and the study group was lower than the control group, which confirmed that the use of Compaxipr can effectively reduce the production of inflammatory factors and vasoactive substances before minimally invasive photocoagulation combined with ultrasonic emulsifying intraocular lens implantation. This is mainly due to the fact that intravitreal injection of Compaq can combine with some VEGF-B and all VEGF-A, and then block neovascularization; after treatment, intraocular hypertension returns to normal, the intraocular microenvironment returns to a stable state, and the level of inflammatory factors decreases.
Vitreous injection of Compaq combined with minimally invasive photocoagulation and phacoemulsification intraocular lens implantation in the treatment of NVG complicated with cataract can improve the levels of serum inflammatory factors and vasoactive substances, effectively reduce intraocular pressure, and improve visual acuity.
Source: Xue Li and Dawei Zhang; Hindawi Journal of Ophthalmology Volume 2023, Article ID 2834398, 5 pages https://doi.org/10.1155/2023/2834398
