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Frequency and Risk Factors for Neovascular Glaucoma After Vitrectomy in Eyes With Proliferative Diabetic Retinopathy

Goto, Akiko, MD; Inatani, Masaru, MD, PhD; Inoue, Toshihiro, MD, PhD; Awai-Kasaoka, Nanako, MD; Takihara, Yuji, MD, PhD; Ito, Yasuhiro, MD, PhD; Fukushima, Mikiko, MD, PhD; Tanihara, Hidenobu, MD, PhD

doi: 10.1097/IJG.0b013e31824d514a
Original Studies

Purpose: To investigate the rate and risk factors for neovascular glaucoma (NVG) after vitrectomy in proliferative diabetic retinopathy (PDR).

Methods: Five hundred and twelve patients (512 eyes) with PDR who underwent vitrectomy between January 1, 2003 and June 30, 2009 at Kumamoto University Hospital, Japan, were retrospectively evaluated. Postoperative NVG was defined as neovascularization in the anterior segment and intraocular pressure (IOP) ≥22 mm Hg after vitrectomy. Kaplan-Meier survival analysis was applied to calculate the rate of NVG after vitrectomy. Risk factors for NVG after vitrectomy were identified by multivariable analysis using the Cox proportional hazards model.

Results: The mean follow-up period was 422 days. Twenty-seven of 512 patients (5.3%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 6.0% and 7.1%, respectively. Male sex [relative risk (RR)=4.247; P=0.0032), younger age (RR=0.956/y; P=0.0237), higher baseline IOP (RR=1.203/mm Hg; P=0.0335), preoperative neovascularization in the anterior chamber angle (RR=8.899; P<0.0001), and presence of NVG in the fellow eye (RR=5.355; P=0.0013) were significant risk factors for postoperative NVG.

Conclusions: The frequency of NVG in PDR eyes within 1 year after vitrectomy was estimated as 7.1%. The risk is independently associated with male sex, younger age, higher baseline IOP, preoperative neovascularization in the angle, and NVG in the fellow eye.

Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

M.I., T.I., Y.T., H.T.: design and conduct of the study; all authors: collection and management of the data; A.G., M.I., T.I., Y.I., M.F.: analysis; all authors: interpretation of the data; A.G., M.I., Y.I., M.F., H.T.: preparation of the first draft of the manuscript; and all authors: review and approval of the manuscript.

All the procedures conformed to the Declaration of Helsinki and informed consent for surgical treatments was obtained from each of the patients participating in the study. The Institutional Review Board of Kumamoto University Hospital, Kumamoto City, Japan, approved the retrospective study protocol. Additional contributions: Mao Miyagawa, BHS, collected the data.

Supported, in part, by grants-in-aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Tokyo, Japan.

Disclosure: The authors declare no conflict of interest.

Reprints: Masaru Inatani, MD, PhD, Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Kumamoto City 860-8556, Japan (e-mail:

Received September 11, 2011

Accepted January 9, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.