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Glaucoma neovascular: estudo descritivo dos aspectos epidemiológicos e oftalmológicos. Proposta de um fluxograma na abordagem terapêutica

Glaucoma neovascular: estudo descritivo dos aspectos epidemiológicos e oftalmológicos. Proposta de um fluxograma na abordagem terapêutica

Autores:

José Paulo Cabral de Vasconcellos,
Vital Paulino Costa,
Newton Kara-José

ARTIGO ORIGINAL

Arquivos Brasileiros de Oftalmologia

versão impressa ISSN 0004-2749versão On-line ISSN 1678-2925

Arq. Bras. Oftalmol. vol.61 no.5 São Paulo out. 1998

http://dx.doi.org/10.5935/0004-2749.19980022

SUMMARY

Purpose:

To investigate: 1. The causes of neovascular glaucoma (NVG) in our population. 2. Possible factors related to the prognosis of NVG. 3. The results of the treatment of NVG.

Methods:

Thirty-eight patients with a diagnosis of NVG, from September 1996 to March 1997, were retrospectively evaluated at the Glaucoma Service of the University of Campinas.

Results:

The most important cause of NVG was proliferative diabetic retinopathy, which was found in 18 patients (47.4%), whereas central retinal vein occlusion was observed in 14 patients (36.8%). The visual acuity at presentation was significantly related to the final visual acuity (p = 0.01). However, initial intraocular pressure and the extension of peripheral anterior sinechiae were not associated with the final visual acuity (p > O. 05). Among the 38 patients, 8 (21.1%) underwent a surgical procedure, which led to a significant decrease of intraocular pressure from 39.75 ± 10.99 mmHg to 21.88 ± 12.14 mmHg (p = 0.01). Five patients (13.1%) achieved IOP control following retinal ablation associated with treatment with drugs. The remaining 25 patients (65.8%) presented with very low visual acuities (light perception or less), which did not justify a surgical procedure. At the end of follow-up, 71.1% of the patients had visual acuity worse or equal to light perception.

Conclusion:

NVG was found to be refractory to treatment and showed an unfavorable visual prognosis. In the attempt to avoid the unfavorable visual outcome of patients with NVG, a flow chart was proposed to guide the treatment of such patients.

Keywords: Neovascular glaucoma; Photocoagulation; Gonioscopy; Intraocular pressure

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