The aim of this study is to observe the efficacy of modified Ahmed glaucoma drainage valve implantation in the treatment of angle-closure neovascular glaucoma.

A total of 45 cases (45 eyes) of neovascular glaucoma with closed angle were collected from October 2017 to January 2021 at Department of Ophthalmology in Handan Eye Hospital. Among them, there were 30 males (30 eyes) and 15 females (15 eyes) with the average age of (59.4±13.5) years, ranged from 35 to 82 years. All patients were injected with 0.05 mg of Lucentis into the vitreous cavity, and were implanted with the modified Ahmed glaucoma drainage valve 3 to 7 d later. Panretinal photocoagulation was performed at 2 weeks after surgery, and the visual acuity, intraocular pressure (IOP), iris neovascularization and complications were observed after surgery for 1 d, 3 d, 7 d, 1 month, 3 months and 6 months. Age, logarithmic minimum angle of resolution (logMAR) visual acuity and IOP conformed to normal distribution and expressed as ±s. The initial response rate of laser therapy and gender are expressed as number of cases and percentage. The IOP of patients at different time points was compared by ANOVA, and further pairwise comparison was performed when the difference was statistically significant.

The logMAR visual acuity before surgery and at the end of surgery was 1.28±0.45, 1.07±0.48 in 45 eyes with angle-closure neovascular glaucoma, respectively. Compared with the preoperative results, 30 cases (30 eyes) had higher visual acuity after operation for 6 months, accounting for 66.7%. There were 15 cases (15 eyes) with no obvious change, accounting for 33.3%. After intravitreal injection of Lucentis for 3 to 7 d, iris neovascularization subsided significantly in all eyes. The IOP of patients was (42.64±7.96) mmHg (1 mmHg=0.133 kPa), (19.11±10.15) mmHg, (12.98±2.80) mmHg, (15.04±4.38) mmHg, (15.47±2.46) mmHg, (15.69±1.98) mmHg and (15.25±1.63) mmHg at 1 day, 3 days, 7 days, 1 month, 3 months and 6 months before and after implantation of the modified Ahmed glaucoma drainage valve. After surgery for 6 months, there were 38 cases (38 eyes) with IOP≤21 mmHg, accounting for 84.44%. There were 7 cases (7 eyes) with IOP ≤21 mmHg, accounting for 15.56% after using 1 to 2 antiglaucoma drugs. The difference of IOP at different time points was statistically significant (F=162.012, P<0.05). There was a significant difference in the IOP of patients between before and after surger at any time point (t=12.81, 25.51, 20.39, 23.87, 22.73, 21.85; P<0.05). There was not a significant difference in the IOP of patients between after surgery for 7 days, 1 month, 3 months and 6 months (F=1.130, P>0.05), which indicating that the IOP of patients tended to be stable. There were 7 patients (7 eyes) with intraoperative anterior chamber hemorrhage, accounting for 15.56%. There was 1 case (1 eye) with conjunctival malocclusion, accounting for 2.22%. Transient anterior chamber bleeding, transient choroidal detachment, periductal iris adhesion and filtration bubble wrapping occurred in 3 cases (3 eyes), 1 case (1 eye), 1 case (1 eye) and 3 cases (3 eyes), respectively, accounting for 6.67%, 2.22%, 2.22% and 6.67%.

Anti-vascular endothelial growth factor, modified Ahmed glaucoma drainage valve implantation and panretinal photo-coagulation in sequential treatment of angle-closure neovascular glaucoma could effectively reduce the IOP and improve the residual visual function of patients.