Combined Posterior Vitrectomy and Ahmed Valve Implantation with Prior Antiangiogenic Application for the Management of Neovascular Glaucoma: A Case Series Study.

Aim and background: This study aims to evaluate the institutional interdisciplinary management protocol for neovascular glaucoma patients, focusing on a combined surgical approach involving posterior vitrectomy and Ahmed valve implantation, with previous antiangiogenic application.

Materials and methods: A retrospective review was conducted for 14 neovascular glaucoma patients who underwent the combined procedure over 4 years. Patients aged 18 years or older with prior antiangiogenic application and without other types of glaucoma or prior posterior vitrectomy were included. Surgical success was assessed as intraocular pressure reduction below 21 mm Hg, either without hypotensive medication (absolute success) or with medication (qualified success) at various time points. Secondary outcomes included intraocular pressure (IOP), number of hypotensive medications, visual acuity, underlying etiology, and postoperative complications.

Results: At baseline, patients had an average IOP of 50 mm Hg and were taking 4.4 glaucoma medications. After the 12-month follow-up, the mean IOP decreased significantly to 16.4 mm Hg, reducing the need for hypotensive medications. The qualified success rate was 100%, while absolute success was not achieved. Visual acuity and anatomical outcomes were maintained, with no cases of anatomical loss. Postoperative complications, including hyphema, choroidal detachment, and vitreous hemorrhage, were transient and self-resolved.

Conclusion: The interdisciplinary management protocol proposed showed favorable results for neovascular glaucoma management. The combined surgical approach led to a considerable reduction in intraocular pressure and glaucoma medication use, indicating a high success rate in controlling the disease. Visual acuity and anatomical outcomes remained stable during the follow-up period, with no cases of anatomical loss.

Clinical significance: This study demonstrates that combining posterior vitrectomy and Ahmed valve implantation, preceded by antiangiogenic therapy, effectively reduces intraocular pressure and glaucoma medication use in neovascular glaucoma patients. This interdisciplinary approach offers improved management and potential for better patient outcomes.

How to cite this article: Belalcazar S, Villa J, Saldarriaga C, et al. Combined Posterior Vitrectomy and Ahmed Valve Implantation with Prior Antiangiogenic Application for the Management of Neovascular Glaucoma: A Case Series Study. J Curr Glaucoma Pract 2025;19(1):3-7.