Thorough Perioperative Laser Photocoagulation in Prevention of Neovascular Glaucoma after Vitrectomy for Diabetic Macular Edema

Abstract

Objectives: Neovascular glaucoma (NVG) is a severe complication that may follow pars plana vitrectomy (PPV) for diabetic macular edema (DME). The objective of this study was to evaluate the effectiveness of perioperative fluorescein angiography (FA) and targeted photocoagulation of the non-perfused area (NPA) in preventing the occurrence of postoperative NVG. Methods: This retrospective, interventional case series study. Vitrectomy for DME was performed by a single surgeon between October 2002 and December 2017. In patients with severe cataracts, FA was performed again after simultaneous phacoemulsification surgery and vitrectomy. When an NPA was detected on FA, targeted photocoagulation was performed on the involved area. Results: Subjects were 52 patients (56 eyes) who received PPV for DME. Fifty-three eyes had non-proliferative diabetic retinopathy, while three had proliferative diabetic retinopathy. The mean postoperative follow-up period was 38.7 ± 25.2 months. A total of 47 eyes (83.9%) eventually underwent pan-retinal photocoagulation. None of the cases developed NVG nor were any other postoperative complications observed. Conclusions: The current study suggests that perioperative FA and adequate retinal PC for NPA are important strategies for preventing post-operative NVG.