|All the studies in this meta-analysis added intravitreal injections to trabeculectomy for NVG, but other approaches such as subconjunctival and anterior chamber injections are also used clinically. Photo: Joseph Sowka, OD. Click image to enlarge.|
Neovascular glaucoma (NVG) is a vision-threatening type of secondary glaucoma that can lead to blindness. It results from various eye lesions that cause retinal ischemia, which is the main pathogenesis of most cases. VEGF has a major role in the formation of ocular neovascularization, and some studies have suggested that anti-VEGF therapy can improve the prognosis of NVG patients. Several randomized controlled trials and retrospective comparative studies have evaluated the postoperative outcomes of trabeculectomy alone or combined with intravitreal injection of anti-VEGF. However, researchers in China noticed that there was a lack of systematic reviews and meta-analyses to analyze the postoperative effects of these two treatments in patients with neovascular glaucoma comprehensively. They performed their own meta-analysis to compare the two different arms in terms of postoperative IOP, surgical success rate and postoperative complications in NVG. Their study concluded that trabeculectomy with anti-VEGF augmentation is superior in short-term outcomes.
The researchers included seven studies with 353 eyes. They compared and analyzed the experimental group and the control group outcomes at six time points: baseline, one week, one month, three months, six months and 12 months postoperatively.
Compared with trabeculectomy alone, trabeculectomy with anti-VEGF had a lower risk of postoperative complications (relative risk; RR=0.60) and higher success rate (RR=1.19). The IOP reduction was significantly greater in the trabeculectomy with anti-VEGF augmentation group than the trabeculectomy group from one week to six months after surgery.
The team also noted that timing, dosage, location and type of anti-VEGF drug administration may influence the surgical outcome and effectiveness.
“After reviewing literatures, we found that IOP is one of the most important criteria for assessing the success of surgery,” the researchers wrote in their paper. Other criteria included the percentage reduction in IOP, as well as the type of antiglaucoma medication compared between pre- and postsurgery.”
“In the future, developing a single set of criteria to evaluate the success of glaucoma surgery may help to advance glaucoma treatment research,” they added.
Zhou X, Chen J, Luo W, Du Y. Short-term outcomes of trabeculectomy with or without anti-VEGF in patients with neovascular glaucoma: a systematic review and meta-analysis. Transl Vis Sci Technol. 2023;12(9):12.