A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma

PURPOSE: This study was aimed to gauge the efficacy of primary AGV implantation with concurrent intraoperative intravitreal ranibizumab vs primary AGV implantation alone in the management of neovascular glaucoma (NVG). METHODS: This retrospective comparative study was carried out based on the data collected in patients of neovascular glaucoma who underwent Ahmed Glaucoma Valve implantation with or without concurrent intravitreal ranibizumab between the period from Feb 2009 to Feb 2015 involving two groups of 40 patients each, having the clinical diagnosis of neovascular glaucoma, having undergone pan-retinal photocoagulation with minimum 03 intravitreal injections of ranibizumab not less than 4 weeks prior to undergoing primary Ahmed glaucoma valve implantation and allotted randomly to either group to receive concurrent administration of intravitreal ranibizumab with Ahmed glaucoma valve (AGV) implant surgery or AGV implant surgery alone. The minimum qualifying follow-up was 3-years. The functional outcome measures included intraoperative and postoperative complications, intraocular pressure (IOP), and the need for antiglaucoma medication, if any, as well as best corrected visual acuity. RESULTS: Both the groups showed a significant decrease in IOP (p < 0.05). Sight and IOP threatening postoperative complications were significantly low in the study group. NVI regression was higher in the study group and re-emergence was significantly lesser in the study group (p = 0.002). Mean postop IOP had shown an excellent reduction in IOP up to 14.25 ± 2.05 mm Hg with 1.5 ± 1 antiglaucoma drugs in ranibizumab group and 15.25 ± 2.95 mm Hg with 1.7 ± 0.87 antiglaucoma drugs in the control group at the 3-years follow-up period. Surgical success rates were comparable between the two groups at 1 and 3-year. CONCLUSION: Concurrent intravitreal ranibizumab along with primary AGV implantation minimizes postoperative complications, regresses NVI while accelerating stabilization of IOP and visual functions. HOW TO CITE THIS ARTICLE: Kaushik J, Parihar JKS, Shetty R, et al. A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma. J Curr Glaucoma Pract 2022;16(1):41–46.