The Challenges in Managing Proliferative Diabetic Retinopathy with Neovascular Glaucoma
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Submitted
October 22, 2015
Published
October 24, 2015
Abstract
Background: The aim of this study is to emphasize the importance of close monitoring of the disease progression, minimize late complication, and knowing the important parameters of succesful treatment.
Methods: A 52 years old woman with proliferative diabetic retinopathy was referred to Vitreoretina division. Patient came with chief complaint blurry vision of the left eye. Patien was diagnosed with diabetes melitus type 2 since 10 months ago. At ophthalmological examination, there was iris neovascularization on the left eye. Due to this finding, patient was given treatment for the proliferative diabetic retinopathy and neovascular glaucoma.
Results: The patient undewent intravitreal injection of bevacizumab and Kehki Meta implant surgery after panretinal photocoagulation laser. Neovascularization of the iris was regressed and the intraocular pressure was controlled.
Conclusion: This patient underwent laser panretinal photocoagulation, bevacizumab injection and Keiki Mehta implant surgery. The result was good. The neovascularization was regressed. Closed monitoring should be continued to evaluate the progression of the disease and control the intraocular pressure to prevent further visual loss.
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Keywords: Proliferative diabetic retinopathy, neovascular glaucoma, diabetic macular edema
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References
Bhavsar AR, Emerson GG, Emerson MV, Browning DJ. Epidemiology of Diabetic Retinopathy: In: Browning DJ, editor. Diabetic Retinopathy : Evidence-Based Management. USA: Springer; 2010. p. 53-76.
Staff AAO. Diabetic Retinopathy. In: Skuta GL, Cantor LB, Weiss JS, editors. Retina and Vitreous. San Fransisco: American Academy of Opthalmology; 2011. p. 109-32.
Gardner TW, Aiello LP. Pathogenesis of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 49-70.
Scanlon PH. Stage R3 : Proliferative diabetic retinopathy and advanced diabetic retinopathy. In: Scanlon PH, Wilkinson CP, Aldington SJ, Matthews DR, editors. A Practical Manual of Diabetic Retinopathy Management. United Kingdom: Wiley-Blackwell; 2009. p. 109-32.
Browning DJ. Diabetic Macular Edema. In: Browning DJ, editor. Diabetic Retinopathy : Evidence-Based Management. USA: Springer; 2010. p. 141-202.
Wolfe JA, Horton MB, McAteer MB, Szuter CF, Clayton T. Race, Macular degeneration, and Diabetic maculopathy. Arch Ophthalmol 1993;111:1603-4.
Pautler SE. Treatment of Proliferative Diabetic Retinopathy. In: Browning DJ, editor. Diabetic Retinopathy : Evidence- Based Management. USA: Springer; 2010. p. 227-304.
Hamanaka T, Akabane N, Yajima T, Takahashi T, Tanabe A. Retinal Ischemia and Angle Neovascularization in Proliferative Diabetic Retinopathy. Am J Ophthalmol 2001;132:648-58.
Bonnet M, Jourdain M, Francoz-Taillanter N. Clinical correlation between rubeosis iridis and optic disc neovascularization. J Fr Ophthalmol 1981;4(5):405-10.
Yazdani S, Hendi K, Pakravan M. Intravitreal bevacizumab (Avastin) injection for neovascular glaucoma J Glaucoma 2007;16:437-9.
Ohrt V. The frequency of rubeosis irids in diabetic patients. Acta Opthalmol 1971;49:301.
Wilkinson CP. Classification of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 13-24.
Guess M, Dubovy SR. Histopathology of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 25-48.
Wilkinson CP, Ferris FL, Klein RE. Proposed international 
clinical diabetic retinopathy and diabetic macular edema 
disease severity scales. Ophthalmology 2003;110:1677-82.
Heriot WJ, Borger JP, Zimmet P, King H, Taylor R, Raper LR. Diabetic retinopathy in a natural population. Aust J 
Ophthalmol 1983;11(3):175-9.
Klein R, Klein BE, Moss SE, Davis MD, DeMets 
DL. The Wisconsin epidemiologic study of diabetic retinopathy.IV.Diabeteic Macular Edema. Ophthalmology 1984;91(12):1464-74.
Klein R, Klein BE, Moss SE. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520-6.
Nguyen QD, Shah SM, Anden E. Supplemental oxygen improves diabetic macular edema : A pilot study Invest Ophthalmol Vis Sci 2004;45:617-24.
Khurana RN, Do DV, Nguyen QD. Anti-VEGF therapeutic approaches for diabetic macular edema. Int Ophthalmol Clin 2009;49:109-19.
Ferrara N, Gerber HP, LeCouter J. The biology of VEGF and its receptors. Nat Med 2003;9:669-76.
Funatsu H, Yamashita H, Noma H. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema. Am J Ophthalmol 2002;133:70-7.
Ho AC, Scott IU, Kim SJ, Brown GC, Brown MM, Ip MS, et al. Anti–Vascular Endothelial Growth Factor Pharmacotherapy for Diabetic Macular Edema : A Report by the American Academy of Ophthalmology. Ophthalmology 2012;119:2179-88.
Michaelides M, Kaines A, Hamilton RD, Fraser-Bell S, Rajendram R, Quhill F, et al. A Prospective Randomized Trial of Intravitreal Bevacizumab or Laser Therapy in the Management of Diabetic Macular Edema (BOLT Study). Ophthalmology 2010;117:1078-86.
Bonini-Filho M, Costa RA, Calucci D, Jorge R, Melo LAS, Scott IU. Intravitreal bevacizumab for diabetic macular edema associated with severe capillary loss : One -year results of a pilot study. Am J Ophthalmol 2009;147:1022-30.
Do DV, Nguyen QD, Boyer D, Schmidt-Erfurth U, Brown DM, Vitti R, et al. One-Year Outcomes of the DA VINCI STudy of VEGF Trap-Eye in Eyes with Diabetic Macular Edema. Ophthalmology 2012;119:1658-65.
Group TDCaCTR. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes melitus. N Engl J Med 1993;329(14):977-86.
Lam A, Anderson NG, Regillo CD, Brown GC. Photography, Angiography, and Ultrasonography in Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 123-38.
Regillo C, Holekamp N, Johnson MW, Kaiser PK, Schubert HD, Spaide R, et al. Diagnostic approach to retinal disease. In: Skuta GL, Cantor LB, Weiss JS, editors. Retina and Vitreous. Singapore: American Academy of Opthalmology; 2011. p. 19-31.
Moshfeghi AA, Scott IU, Flynn HW, Puliafito CA. Optical Coherence Tomography in the management of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 139-60.
Terasaki H, Miyake Y, Mori M. Fluorescein angiography of extreme peripheral retina and rubeosis iridis in proliferative diabetic retinopathy. Retina 1999;19:302-8.
Niki T, Muraoka K, Shimizu K. Distribution of capillary nonperfusion in early-stage diabetic retinopathy. Ophthalmology 1984;91:1431-9.
Shimizu K, Kobayashi Y, Muraoka K. Mid-peripheral fundus involvement in diabetic retinopathy. Ophthalmology 1981;88:601-12.
Ferris FL, Davis MD, Aiello LM, Chew EY. Clinical studies on treatment for diabetic retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 161-82.
Oshima Y, Sakaguchi H, Gomi F, Tano Y. Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol 2006;142(1):155-8.
Gupta N, Mansoor S, Sharma A, Sapkal A, Sheth J, Falatoonzadeh P, et al. Diabetic Retinopathy and VEGF. The Open Ophthalmology Journal 2013;7:4-10.
Mohamed Q, Wong TY. Management of Diabetic Retinopathy : Evidence-based Systematic review. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 265-300.
Group TDCaCTEoDIaCR. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000;342:381-9.
Goff MJ, McDonald HR, I EA. Photocoagulation for Diabetic Macular Edema and Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 183-206.
Wasik A, Song H-F, Grimes A, Engelke C, Thomas A. Bevacizumab in conjunction with panretinal photocoagulation for neovascular glaucoma. Optometry 2009;80:243-8.
Staff AAO. Diabetic Retinopathy. In: Skuta GL, Cantor LB, Weiss JS, editors. Retina and Vitreous. San Fransisco: American Academy of Opthalmology; 2011. p. 109-32.
Gardner TW, Aiello LP. Pathogenesis of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 49-70.
Scanlon PH. Stage R3 : Proliferative diabetic retinopathy and advanced diabetic retinopathy. In: Scanlon PH, Wilkinson CP, Aldington SJ, Matthews DR, editors. A Practical Manual of Diabetic Retinopathy Management. United Kingdom: Wiley-Blackwell; 2009. p. 109-32.
Browning DJ. Diabetic Macular Edema. In: Browning DJ, editor. Diabetic Retinopathy : Evidence-Based Management. USA: Springer; 2010. p. 141-202.
Wolfe JA, Horton MB, McAteer MB, Szuter CF, Clayton T. Race, Macular degeneration, and Diabetic maculopathy. Arch Ophthalmol 1993;111:1603-4.
Pautler SE. Treatment of Proliferative Diabetic Retinopathy. In: Browning DJ, editor. Diabetic Retinopathy : Evidence- Based Management. USA: Springer; 2010. p. 227-304.
Hamanaka T, Akabane N, Yajima T, Takahashi T, Tanabe A. Retinal Ischemia and Angle Neovascularization in Proliferative Diabetic Retinopathy. Am J Ophthalmol 2001;132:648-58.
Bonnet M, Jourdain M, Francoz-Taillanter N. Clinical correlation between rubeosis iridis and optic disc neovascularization. J Fr Ophthalmol 1981;4(5):405-10.
Yazdani S, Hendi K, Pakravan M. Intravitreal bevacizumab (Avastin) injection for neovascular glaucoma J Glaucoma 2007;16:437-9.
Ohrt V. The frequency of rubeosis irids in diabetic patients. Acta Opthalmol 1971;49:301.
Wilkinson CP. Classification of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 13-24.
Guess M, Dubovy SR. Histopathology of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 25-48.
Wilkinson CP, Ferris FL, Klein RE. Proposed international 
clinical diabetic retinopathy and diabetic macular edema 
disease severity scales. Ophthalmology 2003;110:1677-82.
Heriot WJ, Borger JP, Zimmet P, King H, Taylor R, Raper LR. Diabetic retinopathy in a natural population. Aust J 
Ophthalmol 1983;11(3):175-9.
Klein R, Klein BE, Moss SE, Davis MD, DeMets 
DL. The Wisconsin epidemiologic study of diabetic retinopathy.IV.Diabeteic Macular Edema. Ophthalmology 1984;91(12):1464-74.
Klein R, Klein BE, Moss SE. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520-6.
Nguyen QD, Shah SM, Anden E. Supplemental oxygen improves diabetic macular edema : A pilot study Invest Ophthalmol Vis Sci 2004;45:617-24.
Khurana RN, Do DV, Nguyen QD. Anti-VEGF therapeutic approaches for diabetic macular edema. Int Ophthalmol Clin 2009;49:109-19.
Ferrara N, Gerber HP, LeCouter J. The biology of VEGF and its receptors. Nat Med 2003;9:669-76.
Funatsu H, Yamashita H, Noma H. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema. Am J Ophthalmol 2002;133:70-7.
Ho AC, Scott IU, Kim SJ, Brown GC, Brown MM, Ip MS, et al. Anti–Vascular Endothelial Growth Factor Pharmacotherapy for Diabetic Macular Edema : A Report by the American Academy of Ophthalmology. Ophthalmology 2012;119:2179-88.
Michaelides M, Kaines A, Hamilton RD, Fraser-Bell S, Rajendram R, Quhill F, et al. A Prospective Randomized Trial of Intravitreal Bevacizumab or Laser Therapy in the Management of Diabetic Macular Edema (BOLT Study). Ophthalmology 2010;117:1078-86.
Bonini-Filho M, Costa RA, Calucci D, Jorge R, Melo LAS, Scott IU. Intravitreal bevacizumab for diabetic macular edema associated with severe capillary loss : One -year results of a pilot study. Am J Ophthalmol 2009;147:1022-30.
Do DV, Nguyen QD, Boyer D, Schmidt-Erfurth U, Brown DM, Vitti R, et al. One-Year Outcomes of the DA VINCI STudy of VEGF Trap-Eye in Eyes with Diabetic Macular Edema. Ophthalmology 2012;119:1658-65.
Group TDCaCTR. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes melitus. N Engl J Med 1993;329(14):977-86.
Lam A, Anderson NG, Regillo CD, Brown GC. Photography, Angiography, and Ultrasonography in Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 123-38.
Regillo C, Holekamp N, Johnson MW, Kaiser PK, Schubert HD, Spaide R, et al. Diagnostic approach to retinal disease. In: Skuta GL, Cantor LB, Weiss JS, editors. Retina and Vitreous. Singapore: American Academy of Opthalmology; 2011. p. 19-31.
Moshfeghi AA, Scott IU, Flynn HW, Puliafito CA. Optical Coherence Tomography in the management of Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 139-60.
Terasaki H, Miyake Y, Mori M. Fluorescein angiography of extreme peripheral retina and rubeosis iridis in proliferative diabetic retinopathy. Retina 1999;19:302-8.
Niki T, Muraoka K, Shimizu K. Distribution of capillary nonperfusion in early-stage diabetic retinopathy. Ophthalmology 1984;91:1431-9.
Shimizu K, Kobayashi Y, Muraoka K. Mid-peripheral fundus involvement in diabetic retinopathy. Ophthalmology 1981;88:601-12.
Ferris FL, Davis MD, Aiello LM, Chew EY. Clinical studies on treatment for diabetic retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 161-82.
Oshima Y, Sakaguchi H, Gomi F, Tano Y. Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol 2006;142(1):155-8.
Gupta N, Mansoor S, Sharma A, Sapkal A, Sheth J, Falatoonzadeh P, et al. Diabetic Retinopathy and VEGF. The Open Ophthalmology Journal 2013;7:4-10.
Mohamed Q, Wong TY. Management of Diabetic Retinopathy : Evidence-based Systematic review. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. 2nd ed. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 265-300.
Group TDCaCTEoDIaCR. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000;342:381-9.
Goff MJ, McDonald HR, I EA. Photocoagulation for Diabetic Macular Edema and Diabetic Retinopathy. In: Scott IU, Flynn HW, Smiddy WE, editors. Diabetes and Ocular Disease : Past, Present, and Future Therapies. New York: Oxford University Press in cooperation with the American Academy of Ophthalmology; 2010. p. 183-206.
Wasik A, Song H-F, Grimes A, Engelke C, Thomas A. Bevacizumab in conjunction with panretinal photocoagulation for neovascular glaucoma. Optometry 2009;80:243-8.
Authors
Idham, P. A., Elvioza, E., Victor, A. A., Andayani, G., Djatikusumo, A., & Ramayudatha, A. (2015). The Challenges in Managing Proliferative Diabetic Retinopathy with Neovascular Glaucoma. Ophthalmologica Indonesiana, 41(1). https://doi.org/10.35749/journal.v41i1.3
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Idham, P. A., Elvioza, E., Victor, A. A., Andayani, G., Djatikusumo, A., & Ramayudatha, A. (2015). The Challenges in Managing Proliferative Diabetic Retinopathy with Neovascular Glaucoma. Ophthalmologica Indonesiana, 41(1). https://doi.org/10.35749/journal.v41i1.3