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1
Son, Hyeon Woo, Jung Min Park, and Myeong In Yeom. "Neovascular Glaucoma after Diabetic Vitrectomy: Incidence and Risk Factors." Journal of the Korean Ophthalmological Society 62, no. 7 (July 15, 2021): 963–68. http://dx.doi.org/10.3341/jkos.2021.62.7.963.
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Purpose: The prevalence and risk factors of neovascular glaucoma (NVG) after diabetic vitrectomy were evaluated. Methods: This retrospective study included 171 eyes of 141 patients who underwent diabetic vitrectomy in-hospital between March 2013 and July 2019 and were followed for >12 months postoperatively. Regardless of the presence or absence of neovascularization in the anterior segment, all patients received injections of intravitreal bevacizumab during vitrectomy. Patients with preoperative neovascularization in iris (NVI) or angle (NVA) received both intracameral and intravitreal bevacizumab injections. Data were collected regarding baseline demographics, preoperative best-corrected visual acuity, intraocular pressure, hypertension, NVG in the fellow eye, panretinal photocoagulation history, iris and angle neovascularization, and postoperative findings (e.g., rebleeding and residual retinal detachment). Results: In total, 141 patients and 171 eyes were included in the study, and the incidence of postoperative NVG was 5.85% (10 patients). Five patients (27.78%) with preoperative NVI or NVA developed postoperative NVG. Significant risk factors for postoperative NVG were preoperative NVA or NVI (odds ratio [OR] = 16.428, p = 0.003), shorter diabetic duration (OR = 0.853, p = 0.033), and the absence of preoperative panretinal photocoagulation (OR = 0.006, p = 0.035). Conclusions: There is a high possibility of postoperative NVG in patients with preoperative NVI or NVA, a short duration of diabetes, and no preoperative panretinal photocoagulation. In such patients, close monitoring is required after diabetic vitrectomy.
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Urbonavičiūtė, Danielė, Dovilė Buteikienė, and Ingrida Janulevičienė. "A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment." Medicina 58, no. 12 (December 18, 2022): 1870. http://dx.doi.org/10.3390/medicina58121870.
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Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.
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Su, Cheng-Wen, Yue-Cune Chang, Cheng-Li Lin, and Hsin-Yi Chen. "Association of Neovascular Glaucoma with Risk of Stroke: A Population-Based Cohort Study." Journal of Ophthalmology 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/1851568.
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Neovascular glaucoma (NVG), caused by ocular ischemia, is a serious ocular disease complicated by intractably increased intraocular pressure. Cerebrovascular accidents are classified into ischemic and hemorrhagic stroke. Based on the similar pathogenic mechanisms of NVG and ischemic stroke, we investigated the relationship between NVG and stroke by using a nationally representative sample. This study included 416 NVG patients and 4160 controls. Medical comorbidities were also evaluated. The cumulative incidence of ischemic stroke was 15.6% higher in the NVG cohort than in the control cohort (p<0.001); the incidence density rates of stroke were 3.80 and 1.19 per 10,000 person-years in the NVG and control cohorts, respectively. According to the multivariable Cox regression results, the estimated adjusted hazard ratio (aHR) of stroke was 2.07 (95% confidence interval (CI) = 1.41–3.02) for the NVG cohort. Furthermore, the NVG cohort was 2.24-fold more likely to develop ischemic stroke (95% CI = 1.51–3.32). The risk of ischemic stroke was higher in patients with hypertension (aHR = 2.09, 95% CI = 1.55–2.82) and in patients with diabetic retinopathy (aHR = 1.69, 95% CI = 1.05–2.72). Notably, patients with NVG have a higher risk of ischemic stroke, but not hemorrhagic stroke.
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Gubbay, JB, A. Al-Rezqi, M. Hawkes, L. Williams, SE Richardson, and A. Matlow. "The Role of Torovirus in Nosocomial Viral Gastroenteritis at a Large Tertiary Pediatric Centre." Canadian Journal of Infectious Diseases and Medical Microbiology 23, no. 2 (2012): 78–81. http://dx.doi.org/10.1155/2012/134961.
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OBJECTIVE: To describe the viral etiology and epidemiology of nosocomial viral gastroenteritis (NVG) at a tertiary care pediatric hospital and identify any changes over the past two decades.METHODS: Retrospective review of all patients with laboratory-confirmed NVG at The Hospital for Sick Children (Toronto, Ontario), from January 1, 2004, to December 31, 2005.RESULTS: One hundred forty-two episodes of NVG were found among 133 patients, occurring in 0.48 of 100 admissions. The median age was two years; 42% were <1 year of age and 41% were immunocompromised. The most commonly detected pathogen was torovirus (67% of episodes), followed by rotavirus (19%) and adenovirus (9%). Seventy-five cases (53%) were epidemiologically linked in 32 separate clusters (median cluster size two, range two to four). The NVG rate fell from 0.63 of 100 to 0.22 of 100 admissions after March 2005 (P<0.001) when enhanced infection control precautions were instituted in response to an outbreak of vancomycin-resistantEnterococcus.CONCLUSIONS: Torovirus remains the most commonly identified cause of NVG at The Hospital for Sick Children. Most NVG cases were epidemiologically linked, and a significant reduction in cases occurred after the institution of enhanced infection control practices following an outbreak of vancomycin-resistantEnterococcus. Improved education and surveillance for NVG should lead to further reduction in this problem.
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Bilge, Sedat, A. Aydin, and U. Yakut. "Comparative evaluation of the efficacy of using monocular, binocular and panoramic night vision goggles in successful venous access in darkness." BMJ Military Health 166, no. 3 (April 20, 2019): 135–39. http://dx.doi.org/10.1136/jramc-2019-001173.
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IntroductionThe use of night vision goggles (NVGs) by medical staff operating in active combat areas may present a tactical advantage in maintaining unit concealment. This study seeks to assess the degree to which NVG use improves speed and ease of intravenous access in comparison to no NVG use, and which NVG system (monocular, binocular or panoramic) provides the best conditions for the clinician.MethodsCannulation was carried out using both eyes open (BEO) and one eye open (OEO) in well-lit conditions to establish a baseline measurement. The same procedure was then performed with a variety of NVGs, with and without infrared (IR) light sources in a dark room, and the degree of difficulty, time to procedural completion and success rate were compared.ResultsNVG use improved procedure speed in comparison to the BEO method in the dark. Among the NVG methods trialled, binocular NVG (BNVG) methods outperformed panoramic NVG (PNVG) and monocular NVG in terms of success rate.ConclusionsUse of BNVG resulted with a better success rate in our study. We would like to emphasise that although combatant units prefer PNVGs for the wider temporal vision they provide, it must be kept in mind that this may pose a disadvantage in peripheral vascular access procedures while providing first aid to the casualty at close distances.
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Sora, Daisuke, Kei Takayama, Manzo Taguchi, Tomohito Sato, Yutaka Sakurai, Takayuki Kanda, and Masaru Takeuchi. "Topical Corticosteroid-Resolved Rubeosis Iridis with Neovascular Glaucoma Caused by Noninfectious Granulomatous Uveitis." Case Reports in Ophthalmology 9, no. 1 (March 28, 2018): 243–47. http://dx.doi.org/10.1159/000488137.
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Purpose: We report a case of topical corticosteroid treatment-resolved rubeosis iridis with neovascular glaucoma (NVG) caused by noninfectious granulomatous uveitis. Case Report: A 61-year-old woman with left ocular pain and blurred vision was referred to our department. Visual acuity and intraocular pressure (IOP) were 20/60 and 37 mm Hg in the left eye, respectively. Inflammatory cells, hyphema, and rubeosis iridis were observed. All laboratory tests, including multiplex polymerase chain reaction for infection using aqueous humor, were negative, and there was neither retinal occlusive vasculitis nor retinal ischemia in the fundus. Our diagnosis was noninfectious granulomatous anterior uveitis-associated NVG. Topical corticosteroid treatment and anti-glaucoma agents resolved inflammation, rubeosis iridis, and NVG. IOP had decreased to 13 mm Hg by 1 month of treatment, and no recurrence was observed. Conclusion: Topical corticosteroid could resolve rubeosis iridis and NVG in an eye with noninfectious anterior uveitis. The pathogenesis of NVG in eyes with uveitis is still unknown, but inflammation might have a part in angiogenesis. Anti-inflammatory treatment can be selected as the first choice for anterior uveitis-associated NVG.
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Shah, Mittal, David Granger, Tomasz Bobrzynski, Annalisa Baccaro, Jasmine Gore, Vincent Muczynski, Sarah Cook, et al. "A sensitive and robust bioanalytical assay for pharmacokinetic analysis of ROR1xCD3 bispecific T cell engager (NVG-111) in a first-in-human study." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e19505-e19505. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e19505.
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e19505 Background: Receptor tyrosine kinase-like Orphan Receptor-1 (ROR1) is widely expressed on hematological and solid tumors. NVG-111, a first in class humanized tandem scFv ROR1xCD3 bispecific antibody elicits potent killing of ROR1+ tumor cells in vitro and in vivo. This bispecific T-cell engager (TCE) is being evaluated in a first in human, Phase I trial in patients with relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). The predicted therapeutic dose and steady state serum concentrations of NVG-111 were estimated by allometric scaling using relevant doses from a murine PK study. To assess free drug levels in patients following 21 days of continuous infusion of NVG-111, a bespoke, sensitive pharmacokinetics (PK) assay with high levels of specificity and sensitivity was developed. Methods: Anti-idiotype (anti-ID) antibodies directed to anti-ROR1 (αROR1-ID) and anti-CD3 (αCD3-ID) were generated by mouse immunization or by phage display from customized libraries. A proof-of-concept sandwich ELISA assay was developed using αCD3-ID to capture NVG-111 and detection by biotinylated hROR1-streptavidin-HRP. Gyrolab and Quanterix Simoa high sensitivity ELISA platforms were used to detect NVG-111 by αCD3-ID capture and αROR1-ID detection. The mesoscale discovery electrochemiluminescence assay (MSD-ECLA) was developed using a reversed format; NVG-111 capture with αROR1-ID and detection with αCD3-ID. Results: Allometric scaling predicted a theoretically relevant therapeutic dose and steady state serum concentration of 1ng/mL NVG-111 in humans, which was just at the level of sensitivity of a conventional ELISA under non-matrix conditions. Transferring the format to Quanterix Simoa had limited success due to high background levels in all configurations evaluated. The Gyrolab platform increased sensitivity to 75pg/mL, but suboptimal individual human sera matrix selectivity limited assay validity. Assessment of MSD-ECLA provided the best signal/noise, enhanced human disease and healthy sera selectivity, and a dynamic sensitivity range of 250pg/mL to 32ng/mL, which enabled the development of a GCLP qualified PK assay. The MSD-ECLA assay was employed to measure NVG-111 concentrations in CLL or MCL subjects dosed with 0.3-30µg/day NVG-111. MSD-ECLA detected drug in patients receiving NVG-111, with a range of steady-state serum concentrations (Cavg.ss) of 168-610pg/mL. This was in-line with the predicted drug levels from the single species allometric scaling, albeit with observed levels being marginally lower than expected. Conclusions: Development, custom optimization and validation of a highly sensitive MSD-ECLA PK assay has enabled GCLP-compliant measurement of circulating NVG-111 in CLL or MCL patients treated with at least 10µg/day cIV NVG-111.
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Shah, Mittal, David Granger, Tomasz Bobrzynski, Annalisa Baccaro, Jasmine Gore, Vincent Muczynski, Sarah Cook, et al. "A sensitive and robust bioanalytical assay for pharmacokinetic analysis of ROR1xCD3 bispecific T cell engager (NVG-111) in a first-in-human study." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e19505-e19505. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e19505.
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e19505 Background: Receptor tyrosine kinase-like Orphan Receptor-1 (ROR1) is widely expressed on hematological and solid tumors. NVG-111, a first in class humanized tandem scFv ROR1xCD3 bispecific antibody elicits potent killing of ROR1+ tumor cells in vitro and in vivo. This bispecific T-cell engager (TCE) is being evaluated in a first in human, Phase I trial in patients with relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). The predicted therapeutic dose and steady state serum concentrations of NVG-111 were estimated by allometric scaling using relevant doses from a murine PK study. To assess free drug levels in patients following 21 days of continuous infusion of NVG-111, a bespoke, sensitive pharmacokinetics (PK) assay with high levels of specificity and sensitivity was developed. Methods: Anti-idiotype (anti-ID) antibodies directed to anti-ROR1 (αROR1-ID) and anti-CD3 (αCD3-ID) were generated by mouse immunization or by phage display from customized libraries. A proof-of-concept sandwich ELISA assay was developed using αCD3-ID to capture NVG-111 and detection by biotinylated hROR1-streptavidin-HRP. Gyrolab and Quanterix Simoa high sensitivity ELISA platforms were used to detect NVG-111 by αCD3-ID capture and αROR1-ID detection. The mesoscale discovery electrochemiluminescence assay (MSD-ECLA) was developed using a reversed format; NVG-111 capture with αROR1-ID and detection with αCD3-ID. Results: Allometric scaling predicted a theoretically relevant therapeutic dose and steady state serum concentration of 1ng/mL NVG-111 in humans, which was just at the level of sensitivity of a conventional ELISA under non-matrix conditions. Transferring the format to Quanterix Simoa had limited success due to high background levels in all configurations evaluated. The Gyrolab platform increased sensitivity to 75pg/mL, but suboptimal individual human sera matrix selectivity limited assay validity. Assessment of MSD-ECLA provided the best signal/noise, enhanced human disease and healthy sera selectivity, and a dynamic sensitivity range of 250pg/mL to 32ng/mL, which enabled the development of a GCLP qualified PK assay. The MSD-ECLA assay was employed to measure NVG-111 concentrations in CLL or MCL subjects dosed with 0.3-30µg/day NVG-111. MSD-ECLA detected drug in patients receiving NVG-111, with a range of steady-state serum concentrations (Cavg.ss) of 168-610pg/mL. This was in-line with the predicted drug levels from the single species allometric scaling, albeit with observed levels being marginally lower than expected. Conclusions: Development, custom optimization and validation of a highly sensitive MSD-ECLA PK assay has enabled GCLP-compliant measurement of circulating NVG-111 in CLL or MCL patients treated with at least 10µg/day cIV NVG-111.
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Sharma, D., NK Tripathy, V. Raghunandan, and BM Sekhar. "Visual acuity through Night Vision Goggles (NVGs): A comparative assessment between Gen 2++ and Gen 3 NVGs under different illumination conditions." Indian Journal of Aerospace Medicine 65 (August 6, 2021): 17–22. http://dx.doi.org/10.25259/ijasm_15_2021.
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Introduction: During night flying operations, Night Vision Goggles (NVGs) help the aircrew to visualize by intensifying lights reflected from an object. Night sky illumination and image intensification mechanism are the two important factors that affect visual acuity (VA) through NVG. Hence, assessment of visual acuity through Gen 2++ and Gen 3 NVG under different illumination conditions and comparative analysis between the two NVGs was the desired objective of the study. Material and Methods: In a prospective repetitive measure design, a total of 60 volunteered subjects were examined for their VA through Gen 2++ and Gen 3 NVGs using USAF Tri-Bar Chart in the eye lane room of the NVG Lab. The VA was measured under four different illumination conditions; full moon (FM), half moon (HF)quarter moon (QM), and starlight (SL) conditions. The measured VA was converted to logMAR values and analyzed. Results: VA deteriorated significantly with decreasing illuminations through both Gen 2++ (χ2 = 149.9, P < 0.001) and Gen 3 NVGs (χ2 = 156.5, P < 0.001). For Gen 2++ NVG, the difference in VA was statistically significant in all conditions other than between FM and HM. Whereas, it was almost significant for all illumination conditions for Gen 3 NVG. The VA through Gen 2++ was better than Gen 3 in all conditions and the difference in VA widened with decreasing illuminations. Conclusion: VA declined with decreasing illuminations for Gen 2++ as well as Gen 3 NVG, even though, the difference was not significant between FM and HM for Gen 2++ NVG. VA was observed to be consistently better through Gen 2++ NVG compared to Gen 3 across all four illumination conditions. However, keeping in view the dynamic changes in night sky illuminations during flying operations, the findings of the study need to be validated in operational conditions.
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Raghunandan, V., M. Binu Sekhar, N. K. Tripathy, and Vijay Vishnu Joshi. "Study of performance characteristics of ANVIS MK-III night-vision goggle and comparison with other NVGs for aviation usage." Indian Journal of Aerospace Medicine 66 (October 21, 2022): 21–26. http://dx.doi.org/10.25259/ijasm_10_2022.
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Objectives: Night Vision Goggles (NVGs) are widely used in military aviation. Performance of an NVG in terms of high resolution and target acquisition is considered a critical requirement. Gen III NVGs have been considered superior to Gen II and Gen II++ NVGs. The purpose of the study was to evaluate the performance characteristics of ANVIS MK-III NVG and compare them to those of other available NVGs. Material and Methods: ANVIS MK-III Gen III NVG was studied for its performance in terms of visual acuity (VA), contrast sensitivity, and field of view (FOV). Six subjects familiar with use of NVG participated in the study. VA was measured using USAF 1951 Tri-bar chart, while contrast sensitivity was measured using PelliRobson chart under full-moon (FM), half-moon (HF), quarter-moon (QM), and starlight (SL) conditions. The FOV was measured using Cross Bar chart. Comparisons were made with the data of other NVGs available with the Institute. Results: The mean VA of ANVIS MK-III NVG was found to be 20/29, 20/31, 20/34, and 20/39 under of FM, HF, QM, and SL illumination conditions, respectively. The mean contrast sensitivity was 0.9, 0.75, 0.6, and 0.53 log CS units, respectively, with mean FOV of 39.5°. The results were compared with performance characteristics of NL 93, GEO1, and F4949 NVGs. Conclusion: The ANVIS MK-III NVG was found to have higher VA function as compared to other NVGs and better contrast sensitivity function as compared to NL-93 and GEO1 NVG. All the NVGs had comparable FOV. The ANVIS Mk-III NVG in the current configuration with Helmet Display and Tracking System was found to be heavier and needs further ergonomic evaluation.
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Panga, Alina-Adriana, Dan Mircea Stănilă, Adriana Stănilă, and Alexandra Jurcă. "The Damage of Ocular Surface Due to Uncontrolled Intraocular Pressure in Neovascular Glaucoma." Acta Medica Transilvanica 26, no. 1 (March 1, 2021): 28–30. http://dx.doi.org/10.2478/amtsb-2021-0008.
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Abstract Neovascular Glaucoma (NVG) is a severe form of glaucoma characterized by neovascularization and the proliferation of fibrovascular tissue in the anterior chamber angle. Patients with NVG generally present with elevated intraocular pressure (IOP) and may experience severe pain. Ocular surface is affected by high IOP and can lead from moderated to marked conjunctival congestion that is frequently associated with edematous cornea. The aim of the study is to show how the high IOP can affect the ocular surface of the NVG patients and how we can treat and prevent the suffering. Materials and methods: We took in the study a number of 38 eyes from 35 patients with NVG in stage 3 with angle closure glaucoma, that presented high IOP and impaired ocular surface. Results and discussions: The ocular surface was damaged in patients that presented IOP between a minimum of 38 mmHg and maximum of 89 mmHg. The symptoms that patients presented were: conjunctival congestion in particular perikeratic, epithelial and stromal corneal edema, epithelial bubble, corneal ulcerations. Treatment followed rapid drop in IOP and the restoration and protection of ocular surface. The management of neovascular eye with high IOP was medical, laser and surgical. The restoration of ocular surface was made with lubricating hyperosmotic ophthalmic solutions, regenerative and protective agents. In all cases after the treatment was performed the ocular surface was restored. Conclusions: NVG is a very difficult pathology and is very hard to manage. The uncontrolled IOP in NVG patients affect the ocular surface and leads to complications. Long-term maintenance of normal intraocular pressure is important in NVG management but also in protecting the ocular surface.
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Granger, David, Satyen Gohil, Alessandro Barbarulo, Annalisa Baccaro, Vincent Muczynski, Kerry Chester, Fiona Germaschewski, et al. "NVG-111, a novel ROR1xCD3 bispecific antibody for non-Hodgkin lymphoma." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 7549. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.7549.
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7549 Background: Receptor tyrosine kinase-like Orphan Receptor 1 (ROR1) is a type I transmembrane protein is highly expressed on an array of haematological and solid tumours. NVG-111 is a humanised, tandem scFv ROR1xCD3 bispecific antibody previously shown to elicit potent killing of tumour cells in vitro and in vivo by engaging a membrane-proximal epitope in the Wnt5a-binding Frizzled domain of ROR1 and redirecting T cell activity. The in vitro potency and pharmacodynamic responses to NVG-111 were assessed to support progression to a first-in-human study. Methods: The potency of NVG-111 in vitro was determined by evaluating the concentration response for cytotoxicity, T cell activation, and cytokine release in co-cultured Jeko-1 and unstimulated human T cells. Comparative data were generated for the marketed CD19xCD3 bispecific antibody, blinatumomab. Potency data for NVG-111 were used together with allometric scaling from murine PK studies to inform planned clinical doses. Results: NVG-111 demonstrated T cell-dependent cytotoxicity, T cell activation and levels of cytokine release similar in potency to blinatumomab. Cytotoxic responses of both NVG-111 and blinatumomab were more potent than T cell activation and cytokine release. Dose response curves for NVG-111 showed a decrease in activity beyond the concentration of maximal response (ie “hook effect”). We hypothesise this is due to receptor saturation, inhibiting synapse formation. NVG-111 has progressed to a Phase 1/2 first-in-human study in patients with debulked, relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), the drug given as add-on to ≥2nd line therapy with a Bruton’s tyrosine kinase inhibitor, or venetoclax. Phase 1 includes escalating doses of 0.3 to 360 µg/day via continuous infusion over 3 cycles (each 21 days on, 7 days off) to establish safety, PK, pharmacodynamics (PD) and recommended phase 2 dose (RP2D). Predicted exposure at 0.3 µg/day is ̃EC20 for cytotoxicity in vitro and below the lowest EC10 for cytokine release. PD biomarkers in the study include systemic cytokines. Phase 2 will study efficacy and safety of the RP2D in CLL and MCL, with primary endpoint complete response rate; other efficacy endpoints include minimal residual disease and progression free survival. Conclusions: NVG-111 shows potent T-cell mediated lymphoma cell cytotoxicity in vitro at concentrations well below those associated with extensive cytokine release. NVG-111 is in an ongoing Phase 1/2 study and may present a novel option for adoptive immunotherapy in patients with non-Hodgkin lymphoma and potentially other cancers. Clinical trial information: 2020-000820-20. [Table: see text]
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Ajayi, Iyiade, Olusola Omotoye, Kayode Ajite, and Emmanuel Abah. "Presentation, etiology and treatment outcome of neovascular glaucoma in Ekiti state, South Western Nigeria." African Health Sciences 21, no. 3 (September 27, 2021): 1266–72. http://dx.doi.org/10.4314/ahs.v21i3.37.
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Background: Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical loca- tions.
Objective: The objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital.
Method: A retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25.
Results: 29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up.
Conclusion: NVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices.
Keywords: Neovascular glaucoma; retinal ischemia; rubeosis iridis; secondary glaucoma.
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Miao, Heng, Xianru Hou, De-Kuang Hwang, and Yong Tao. "Vascular Endothelial Growth Factor, Basic Fibroblast Growth Factor, and Pigment Epithelium-Derived Factor Expression in the Neovascular Iris in Retinal Diseases." Journal of Ophthalmology 2018 (2018): 1–6. http://dx.doi.org/10.1155/2018/8025951.
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Objective. To determine the expression of cytokines in the iris of patients with neovascular glaucoma (NVG). Methods. Patients with NVG associated with proliferative diabetic retinopathy (PDR, group 1) or central retinal vein occlusion (CRVO, group 2) who had undergone surgical treatment were enrolled. Patients with primary open-angle glaucoma requiring surgical treatment were included in the control group (group 3). All iris specimens were obtained during trabeculectomy, 7 days after intravitreal injections of ranibizumab. The messenger RNA (mRNA) and protein levels of three target cytokines—vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and pigment epithelium-derived factor (PEDF)—in the iris were analyzed and compared. Results. We included 39 eyes from 39 patients (12, 15, and 12 in groups 1, 2, and 3, resp.). The protein and mRNA levels of PEDF were higher in two NVG groups. The protein levels, but not mRNA level, of bFGF were higher in the two NVG groups. The protein and mRNA levels of VEGF were similar in the three groups. Conclusions. The protein level of bFGF increased in the irises of the NVG patients was not expressed by the iris itself, whereas PEDF may be expressed by the iris tissue in these patients.
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Ryu, Christina L., Adrian Elfersy, Uday Desai, Thomas Hessburg, Paul Edwards, and Hua Gao. "The Effect of Antivascular Endothelial Growth Factor Therapy on the Development of Neovascular Glaucoma after Central Retinal Vein Occlusion: A Retrospective Analysis." Journal of Ophthalmology 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/317694.
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Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes.Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG.Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average.Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes.
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Nakano, Satoko, Takako Nakamuro, Katsuhiko Yokoyama, Kunihiro Kiyosaki, and Toshiaki Kubota. "Prognostic Factor Analysis of Intraocular Pressure with Neovascular Glaucoma." Journal of Ophthalmology 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/1205895.
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Purpose. To perform multivariate analysis for identifying independent predictors of elevated intraocular pressure (IOP) with neovascular glaucoma (NVG), including antivascular endothelial growth factor (VEGF) intravitreal injections.Methods. We retrospectively reviewed 142 NVG patients (181 eyes) with ischemic retinal diseases [proliferative diabetic retinopathy (PDR) in 134 eyes, retinal vein occlusion (RVO) in 29, and ocular ischemic syndrome in 18]. We analyzed age, gender, initial/final LogMAR VA, initial/final IOP, extent of iris and/or angle neovascularization, treatments, preexisting complications, concurrent medications, and follow-up duration.Results. The mean follow-up duration was 23.8 ± 18.8 months. At the final follow-up, 125 (72.3%) eyes had IOP ≤ 21 mmHg. NVG patients with RVO had a higher degree of angle closure and higher IOP. NVG with PDR had better IOP and LogMAR VA. Angle closure had the greatest impact on final IOP. Greater than 90% of patients treated with trabeculectomy with mitomycin C (LEC) had persistent declines in IOP (≤21 mmHg). Stand-alone and combination anti-VEGF therapies were not associated with improved long-term prognosis of IOP.Conclusions. Angle closure was found to have the greatest effect on NVG-IOP prognosis. When target IOP values are not obtained after adequate PRP with or without anti-VEGF, early LEC may improve the prognosis of IOP.
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Gibb, Randall W., and Jack D. Reising. "Assessing the Effect of Incompatible Light on Night Vision Goggle Performance." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 41, no. 2 (October 1997): 1098–102. http://dx.doi.org/10.1177/107118139704100282.
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Current specifications indicate that cockpit lighting designed for night vision goggle (NVG) operations is compatible with NVGs if it does not degrade NVG-aided visual acuity (VA). This study compared two measures of VA; USAF Tri-Bar Chart and NVG Chart. NVG-aided contrast sensitivity (CS) also was assessed; three CS charts having spatial frequencies (SF) of 3, 6, and 12 cycles/degree (cpd) were developed. VA and CS were measured with either low or high levels of incompatible light present. Results revealed that performance did not differ between the two VA measures. Under low incompatible light, CS was degraded only for the high SF. Under high incompatible light, CS was degraded for all SFs. These results suggest that the choice of VA measure should depend upon evaluation factors (e.g., available time, sample size). CS can be used as an alternative to VA and may provide a more complete index of cockpit lighting compatibility.
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Troell, Robert J., Nelson B. Powell, Robert W. Riley, and Kasey K. Li. "Evaluation of a new procedure for nasal alar rim and valve collapse: Nasal alar rim reconstruction." Otolaryngology–Head and Neck Surgery 122, no. 2 (February 2000): 204–11. http://dx.doi.org/10.1016/s0194-5998(00)70240-3.
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OBJECTIVE A new operative technique to improve nasal valve collapse by placement of cartilage struts along the alar rim was compared with the standard nasal valve cartilage graft (NVG) technique. METHODS AND PATIENTS A retrospective study of consecutive patients with nasal valve collapse was performed at Stanford University Medical Center. Seventy-nine patients with nasal valve collapse underwent reconstruction with either the classic NVG technique or a newly developed nasal alar rim reconstructive (NARR) procedure. The mean age of the NARR group was 50.13 years (SD ± 9.40), with 36 men (92.3%) and 3 women (7.7%). The mean age of the NVG group was 52.14 years (SD ± 10.83), with 36 men (90%) and 4 women (10%). MAIN OUTCOME MEASURES These included functional and subjective evaluation of nasal valve collapse. RESULTS Forty patients (50.6%) underwent the NVG technique, and 39 (49.4%) received the NARR procedure. The NVG technique revealed 0% worsened, 15.0% (6/40) unchanged, 25.0% (10/40) improved, and 60% (24/40) free of obstruction. The NARR procedure revealed 2.6% worsened, 2.6% unchanged, 7.7% improved, and 87.1% free of obstruction. CONCLUSIONS Nasal alar cartilage struts placed along the caudal alar rim offers sufficient support to the alar rim and valve area. This procedure appears to be as effective as currently available reconstructive alternatives, while being technically uncomplicated.
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Lazcano-Gomez, Gabriel, Jeffrey R. Soohoo, Anne Lynch, Levi N. Bonell, Karina Martinez, Mauricio Turati, Roberto Gonzalez-Salinas, Jesus Jimenez-Roman, and Malik Y. Kahook. "Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico." Journal of Current Glaucoma Practice 11, no. 2 (2017): 48–51. http://dx.doi.org/10.5005/jp-journals-10028-1222.
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ABSTRACT Aim To describe the demographic characteristics, ocular comorbidities, and clinical outcomes of patients with neovascular glaucoma (NVG) and to determine the number of patients who returned for a follow-up eye examination. Materials and methods We examined the clinical data of patients with NVG, who attended a glaucoma clinic between July 2010 and November 2014. We collected information on the demographic characteristics of the patients to include the level of education, ocular comorbidities, NVG stage, visual acuity, glaucoma medications, intraocular pressure (IOP), and the number of patients who had a follow-up ocular examination at month 1, 3, 6, and 12. Results Data from 350 patients (473 eyes) with NVG were collected. We found 91% of the cohort had proliferative diabetic retinopathy (PDR). We found blindness in both or one eye in 14% and 31% of the cohort respectively. Low vision was found in both or one eye in 14% and 32% of the eyes respectively. By 6 months follow-up, only 32% of the patients were seen at our clinic and by 12 months follow-up, this number decreased to 15%. Around 60% of the patients were on no IOP lowering drugs at the first visit. We found 53% of the cohort had an incomplete elementary school education. Conclusion The results suggest that advanced NVG is a significant ocular problem for patients referred to our clinic with just over half of the patients presenting as blind. We also found that several socioeconomic factors that had an important role in the development of PDR and NVG, specifically, educational status. Clinical significance We described the characteristics of a large cohort of patients with very advanced NVG, reflecting the fact that the strict control of the underlying disease must be the main goal of the Mexican national health system. How to cite this article Lazcano-Gomez G, Soohoo JR, Lynch A, Bonell LN, Martinez K, Turati M, Gonzalez-Salinas R, Jimenez-Roman J, Kahook MY. Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico. J Curr Glaucoma Pract 2017;11(2):48-51.
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Bernal-Morales, Carolina, Alvaro Olate-Perez, Manuel J. Navarro-Angulo, Laura Pelegrín, and Marc Figueras-Roca. "Simultaneous pars plana vitrectomy, panretinal photocoagulation, cryotherapy, and Ahmed valve implantation for neovascular glaucoma." International Journal of Ophthalmology 14, no. 9 (September 18, 2021): 1396–401. http://dx.doi.org/10.18240/ijo.2021.09.15.
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AIM: To describe and evaluate the efficacy of Ahmed glaucoma valve implantation (AGV) combined with pars plana vitrectomy (PPV) in a single surgical act for the treatment of advanced neovascular glaucoma (NVG). METHODS: Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV, AGV, and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period (2005-2018). Preoperative, intraoperative and postoperative data at day 1 and months 1, 3, 6, 21, and 24 were systematically collected. Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment. RESULTS: Main indications for surgery were NVG secondary to proliferative diabetic retinopathy (39.2%) and central retinal vein occlusion (37.3%). Mean (±SD) preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12mo and 15.8±9.1 mm Hg at 24mo of follow up. Cumulative incidence of success of IOP control was 76.0% at first postoperative month, reaching 88.3% at 6mo. Prevalence of successful IOP control at long term was 74.4% at 12mo and 71.4% at 24mo. Eye evisceration for unsuccessful NVG management was required in 1 case (2.0%). CONCLUSION: Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.
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Бикбов, Mukharram Bikbov, Хуснитдинов, and Ilnur Khusnitdinov. "EFFECTIVENESS OF EX-PRESS AND AHMED DRAINAGE DEVICES IN PATIENTS WITH SECONDARY NEOVASCULAR GLAUCOMA." Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук 1, no. 6 (December 20, 2016): 28–31. http://dx.doi.org/10.12737/23719.
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The purpose of the study was to compare the efficacy of Ex-Press and Ahmed drainage devices for the secondary neo-vascular glaucoma (NVG) in patients with diabetes mellitus. We observed 25patients (25eyes) with secondary NVG in the setting of proliferative diabetic retinopathy. The first group consisted of 10patients (10eyes) who underwent Ex-Press drainage implantation. The second group consisted of 15patients (15eyes) who were implanted Ahmed valve FP7 model. As a result the maximum value of IOP in the analyzed groups decreased by 66.8% and 64.2% respectively immediately after the surgery. By the end of 18months follow-up period, the absolute hypotensive effect in patients of group1 was 20% (2/10) whereas in group2 – 60% (9/15). Normal intraocular tension during treatment with glaucoma medications established in 30% of cases in group1 (3/10) and in 80% of patients in group2 (12/15). Thus, the use of Ex-Press drainage device for secondary NVG in patients with diabetes was ineffective in 70% of cases. We can recommend choosing implantation of Ahmed valve for secondary NVG in patients with diabetes mellitus as the number of unsuccessful outcomes using Ahmed valve was observed only in 20% of cases.
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Hasanreisoglu, Murat, Dov Weinberger, Karin Mimouni, Moshe Luski, Dan Bourla, Michal Kramer, Anat Robinson, and Ruth Axer-Siegel. "Intravitreal Bevacizumab as an Adjunct Treatment for Neovascular Glaucoma." European Journal of Ophthalmology 19, no. 4 (July 2009): 607–12. http://dx.doi.org/10.1177/112067210901900414.
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Purpose To assess the effect of adjunctive intravitreal bevacizumab treatment on neovascular glaucoma (NVG). Methods The medical records of all consecutive patients with NVG treated with intravitreal bevacizumab at our center from May 2006 to February 2008 were reviewed. The data collected included background features, findings on full ophthalmologic examination (including visual acuity, gonioscopy, and intraocular pressure), glaucoma medications prescribed, and additional procedures for glaucoma performed before and after bevacizumab injection. The interval between the diagnosis of NVG and intravitreal bevacizumab treatment was calculated. Results Eighteen patients (6 male, 12 female; mean age 63±13.2 years) met the study criteria. Causes of NVG were proliferative diabetic retinopathy (n=14), central retinal vein occlusion (n=2), occlusive vasculitis (n=1), and panuveitis (n=1). The mean duration of follow-up was 52 (±12) weeks. Mean intraocular pressure decreased from 32.3 (±4.99) to 18 (±6.1) mmHg (p<0.0001) and mean number of glaucoma medications decreased from 3.16 (±1.2) to 2.55 (±1.46) (p=0.1938). An interval of less than 6 months between the start of bevacizumab treatment and diagnosis was associated with better final visual acuity than delayed treatment (0.82±0.4 logMAR vs 1.88±1.1 logMAR, p=0.002) and a better regression of iris neovascularization (22% vs 89%; p=0.015). Conclusions Intravitreal bevacizumab is beneficial for the treatment of anterior segment neovascularization and NVG when used as an adjunct, making the administration of additional treatment for the underlying cause possible. Bevacizumab should be instituted promptly after diagnosis, before irreversible anatomic and functional damage occurs.
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Mannava, Sishir, Luis F. Torres, Keith G. DeSousa, Dileep R. Yavagal, Nicolas A. Yannuzzi, Harry W. Flynn, and Amer M. Malik. "Severe Neovascular Glaucoma Exacerbation as a Complication of Carotid Artery Stenting: A Case Report." Neurohospitalist 10, no. 4 (May 22, 2020): 301–4. http://dx.doi.org/10.1177/1941874420923914.
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Introduction: Neovascular glaucoma (NVG) has been rarely reported as an acute complication of carotid endarterectomy, but there is scant literature available regarding this potential condition following carotid artery stenting (CAS). We present a case of severe worsening of NVG occurring after bilateral CAS with progressive deterioration of vision ultimately leading to blindness. Case Description: A 66-year-old male with multiple stroke risk factors, bilateral cataract extraction, proliferative diabetic retinopathy of left eye, and nonproliferative diabetic retinopathy of right eye, and prior left eye pars plana vitrectomy presented with episodes of transient right eye vision loss in context of bilateral high-grade internal carotid artery stenoses. He underwent right CAS with subsequent elevation of bilateral intraocular pressures (IOPs) concerning for acute NVG. Over time, the patient had some interval improvement in IOPs and underwent planned left CAS. After the procedure, he again developed elevated IOPs, concerning for acute NVG which eventually led to right eye pars plana vitrectomy for vitreous hemorrhage and refractory IOP elevation. At 6-month follow-up from initial stenting, the patient was blind in both eyes. Discussion: We present a case of recurrent IOP elevations following CAS eventually resulting in bilateral eye blindness. This case is important not only as an illustration of an underrecognized postprocedural CAS complication but also as a demonstration of likely elevated risk of NVG following CAS for patients with other predisposing risk factors for ocular hypertension such as glaucoma, proliferative diabetic retinopathy, prior cataract extraction, and prior pars plana vitrectomy.
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Kobayashi, Yui, Shunsuke Nakakura, Etsuko Terao, Yuki Fujio, Kanae Matsuya, Hitoshi Tabuchi, Yasuhiro Takahashi, and Yoshiaki Kiuchi. "Iris Morphological Features in Patients with 360° Angle-Closure Neovascular Glaucoma: An Anterior Segment Optical Coherence Tomography Study." Case Reports in Ophthalmology 9, no. 3 (October 25, 2018): 449–56. http://dx.doi.org/10.1159/000493418.
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Purpose: To investigate iris morphological features in 360° angle-closure neovascular glaucoma (NVG) by swept-source anterior segment optical coherence tomography (ASOCT). Patients and Methods: In this retrospective, clinic-based, comparative study, 14 patients with 360° angle-closure NVG and 14 healthy age-matched control subjects were enrolled. All patients enrolled had no prior glaucoma surgery but underwent cataract surgery with intraocular lens implantation. Horizontal scanning images of swept-source ASOCT were analyzed using software calipers in temporal and nasal angle areas. The iris thickness at 1 and 2 mm from the pupil edge, iris length, trabecular meshwork length, peripheral anterior synechia (PAS) length, PAS height ratio (PAS length/trabecular meshwork length), and pupil diameter were measured. Results: Between the groups, there were no statistically significant differences in iris length, trabecular meshwork length, and pupil diameter (p > 0.05). However, the iris thickness was significantly reduced in the NVG group compared with the control group in the temporal and nasal areas (0.306 vs. 0.563 mm/0.326 vs. 0.645 mm at 1 mm, 0.278 vs. 0.523 mm/0.282 vs. 0.546 mm at 2 mm, respectively) (mean, all p < 0.001). In the NVG group, PAS height ratios were 1.55 ± 0.45 (mean ± standard deviation) (range, 0.58–2.30) and 1.55 ± 0.78 (range, 0.68–3.68) at the temporal and nasal angles, respectively. Conclusions: In patients with 360° angle-closure NVG, the iris thickness decreased to about 50% of that in healthy subjects, and the PAS length exceeded the trabecular meshwork length by about 1.5 times.
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Xu, Yang. "The moderating effect of founding assets on the founders’ human capital." New England Journal of Entrepreneurship 22, no. 2 (October 14, 2019): 126–42. http://dx.doi.org/10.1108/neje-05-2019-0027.
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Purpose The purpose of this paper is to investigate into the conditions under which founders’ human capital (HC) benefits new venture growth (NVG). One such condition is investigated in this study – initial assets at founding. Specifically, founding assets are hypothesized to moderate the relationship between founders’ HC and NVG. Design/methodology/approach The longitudinal panel database from the Kauffman Firm Survey for the period 2004–2011 was used to test the hypotheses. The final sample consisted of 4,923 firms, with 34,461 observations made over seven years. Findings The regression analysis found the effect of founders’ HC on NVG and the moderating role of founding assets in the HC–NVG relationship. Research limitations/implications New ventures benefit even more from founders’ education level, industry and startup experiences when the startups have larger assets at founding. The effect of founders’ education and experiences on startup growth is contingent upon the initial assets at founding. Practical implications The results of this study can help practitioners and policy makers to understand the drivers of NVG and the interactions among these drivers. Growth-oriented startups may require a large investment in founding assets such as production facilities. Startups with fewer founding assets may find it particularly difficult to negotiate with external stakeholders and may face unusually intense competitive responses from competitors. Policy makers should tailor the support to the founding conditions of new firms. Originality/value The prior literature has shown mostly the independent positive effects of various resources on firm growth. This study argues and empirically shows that startups grow faster when founders with high HC have more assets to utilize. The resource-based view literature was expanded by adding important new causal mechanisms, enriching our understanding of how founders’ HC interact with founding assets, jointly affecting NVG. Like a big fish in a small pond, even highly educated and experienced entrepreneurs have limited opportunities to utilize their talents in a startup with a lower initial resource position.
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Jasani, Parag, William Townsend, Samir Asher, Sarrah Tayabali, David Tucker, Sarah Cook, Toby Batten, et al. "First-in-human phase I study of a ROR1-targeting bispecific T-cell engager (NVG-111) shows evidence of efficacy in patients with relapsed/refractory CLL and MCL." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 7535. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.7535.
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7535 Background: NVG-111 is a first in class, humanized, tandem scFv ROR1xCD3 bispecific T cell engager that mediates potent killing of ROR1+ tumours by engaging an epitope on the Frizzled domain of ROR1 and redirecting T cell activity via the CD3 binder. Methods: This phase I/II study is evaluating NVG-111 in patients with relapsed/refractory (R/R) CLL and MCL who have received ≥2 prior systemic therapies and have achieved a stable, or partial response to the last line of therapy. NVG-111 was delivered as continuous intravenous (cIV) infusion over 21 days per cycle, with each patient typically receiving 3 cycles of treatment. The first 3 single patient cohorts were subjected to accelerated dose titration (ADT) over a range of 0.3-30µg/day. Dose-escalation steps in the subsequent, multi-patient, cohorts were determined using a continuous reassessment method with overdose control. The primary endpoints are safety and determination of MTD/RP2D. Secondary objectives are pharmacokinetics, pharmacodynamics, immunogenicity and anti-tumor activity, assessed by multicolor flow cytometry to quantitate minimal residual disease (MRD4). Results: As of January 2022, six patients (all males, median age 60 years) had been enrolled to the study; three into each of the ADT cohorts and the remaining into a 30 µg/day flat dosing cohort. Five patients had CLL, and one had MCL, with all subjects remaining on ibrutinib whilst receiving NVG-111. The most common adverse events were Grade 1 lethargy, headaches, nausea, vomiting and thrombocytopenia. All 3 patients exposed to a flat dose of NVG-111 at 30µg/day suffered Grade 1 cytokine release syndrome (CRS) during week 1 of cycle 1. This did not require tocilizumab or dose interruption except in one patient who developed transient, grade 3 immune effector cell–associated neurotoxicity syndrome-like symptoms (ICANS). CRS or ICANS was not observed in subsequent cycles of treatment at this dose level. Response was observed in all 5 evaluable patients who had completed efficacy assessment after 3 cycles of NVG-111. Amongst these, 2 patients had undetectable MRD in the blood with one being MRD negative in the bone marrow. Dose escalation is ongoing, including exploration of step-up dosing. Conclusions: Early data with NVG-111 shows promising efficacy with a predictable and manageable safety profile. Clinical trial information: NCT04763083.
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Putera, Ikhwanuliman, Astrianda N. Suryono, and Widya Artini. "Challenging Management of Neovascular Glaucoma to Achieve the Best Visual Outcome." Case Reports in Ophthalmology 11, no. 1 (February 19, 2020): 85–91. http://dx.doi.org/10.1159/000506041.
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Neovascular glaucoma (NVG) resulting from ischemic insults caused by various diseases, such as proliferative diabetic retinopathy and central vein occlusion, remains a challenging situation. This case report aims to describe the complex management of NVG, resulting from diabetic retinopathy, to achieve the best visual outcome. A 47-year-old male presented with poor visual acuity of both eyes. His right eye was inoperable. Ahmed valve implantation with intraoperative intravitreal bevacizumab injection was performed in his left eye. Panretinal photocoagulation was performed serially after phacoemulsification. However, intraocular pressure was found to be raised, thus necessitating 5-fluorouracil needling bleb revision and administration of intracameral bevacizumab injection. During 15 months of follow-up we were able to achieve the best visual outcome possible in this patient. Comprehensive management of NVG should be implemented with a multidisciplinary approach.
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Kameda, Yusuke, Tadashiro Saeki, Ko Hanai, Yuta Suzuki, Yasuko Uchigata, Tetsuya Babazono, and Shigehiko Kitano. "Is Chronic Kidney Disease Affecting the Postoperative Complications of Vitrectomy for Proliferative Diabetic Retinopathy?" Journal of Clinical Medicine 10, no. 22 (November 15, 2021): 5309. http://dx.doi.org/10.3390/jcm10225309.
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Chronic kidney disease (CKD) is a well-known risk factor for postoperative complications in several surgical fields. However, although prevalent among diabetic candidates for vitrectomy, the effect of CKD on vitrectomy outcomes remains unclear. This study aimed at clarifying the relationship between CKD and the occurrence of vitrectomy-related complications in patients with proliferative diabetic retinopathy (PDR). The 6-month incidences of vitreous hemorrhage (VH) and neovascular glaucoma (NVG) following vitrectomy for PDR were compared among the following groups: stages 1–2 CKD (60 patients), stages 3–5 CKD (70 patients not on hemodialysis), and hemodialysis (HD; 30 patients). We also determined whether the deterioration of the estimated glomerular filtration rate (eGFR) was associated with post-vitrectomy events. The incidence of VH was significantly higher in the stages 3–5 CKD group (43%) than in the stages 1–2 CKD (10%) and HD (10%) groups. NVG was more common in the stages 3–5 CKD group (17%) than in the stages 1–2 CKD (2%) and HD (0%) groups. The reduced estimated glomerular filtration rate (eGFR) was the only significant variable associated with post-vitrectomy VH and NVG. Patients with PDR and CKD, particularly those with lower eGFR, might be at risk for post-vitrectomy VH and NVG.
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Wang, Menghua H., Qiuming M. Li, Hongtao T. Dong, Shuqian Q. Dong, Yang Li, and Chunyan Y. Zheng. "Ahmed Valves vs Trabeculectomy Combined with Pans Plana Vitrectomy for Neovascular Glaucoma with Vitreous Hemorrhage." European Journal of Ophthalmology 27, no. 6 (April 14, 2017): 774–80. http://dx.doi.org/10.5301/ejo.5000973.
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Purpose Vitreous hemorrhage is common in advanced neovascular glaucoma (NVG), which has poor visual prognosis. This study aimed to compare the efficacy of 23-G pars planar vitrectomy (PPV) combined with either Ahmed glaucoma valve (AGV) implantation or trabeculectomy after intravitreal ranibizumab (IVR) treatment for NVG with vitreous hemorrhage. Methods This retrospective, nonrandomized study included 33 eyes of 33 patients with NVG with vitreous hemorrhage. After IVR treatment for 3-7 days, 18 eyes underwent PPV + AGV (AGV group) and 15 underwent PPV + trabeculectomy (trabeculectomy group). The success criterion was a postoperative intraocular pressure (IOP) of 6-21 mm Hg, with or without antiglaucoma medication. Results Postoperative IOP decreased significantly in both groups, but the mean IOP after 12 months was significantly lower in the AGV group (16.92 ± 2.75 mm Hg) than the trabeculectomy group (21.50 ± 5.79 mm Hg; p = 0.018). The AGV group required fewer glaucoma medications than the trabeculectomy group. The cumulative probabilities of surgical success rates for the AGV and trabeculectomy groups at 12 months were 71.3% and 46.7%, respectively. No significant differences in postoperative complications were observed between the groups. Conclusions For NVG with vitreous hemorrhage, PPV with AGV implantation may reduce IOP more effectively than PPV with trabeculectomy.
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Недзвецкая, О. В., де Г. О. В. Кузьмина, Н. А. Гончарова, И. В. Пастух, И. А. Соболева, and Н. М. Воронцова. "Changes in the Retina and Choroid of the Eye with Painful Neovascular Glaucoma of Post-Thrombotic and Diabetic Genesis." Офтальмология. Восточная Европа, no. 1 (February 23, 2021): 39–50. http://dx.doi.org/10.34883/pi.2021.11.1.004.
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Цель. Определить сходство и различия в морфологических изменениях сосудистой и сетчатой оболочек глаз с терминальной болевой неоваскулярной глаукомой посттромботического и диабетического генеза.Материалы и методы. Изучено 57 энуклеированных глазных яблок (344 препарата): 1-я группа – 156 препаратов из 26 глаз с неоваскулярной глаукомой (НВГ), развившейся вследствие тромбоза центральной вены сетчатки (ЦВС) или ее ветвей; 2-я группа – 188 препаратов из 31 глаза с НВГ, развившейся у пациентов с сахарным диабетом (СД) и пролиферативной диабетической ретинопатией (ПДР). Гистологические срезы окрашивали гематоксилином и эозином и по Ван-Гизон. Анализировали по 5–6 срезов каждого глазного яблока с помощью микроскопа Olimpus BX-41 при увеличении ×200–400.Результаты и обсуждение. В группе с посттромботической НВГ в отличие от группы с диабетической НВГ в 4 раза чаще встречались тромбы в сосудах цилиарного тела (ЦТ) и радужной оболочки (РО) и в 4,8 раза чаще – в сосудах хориоидеи. В группе с НВГ на фоне СД в отличие от группы с посттромботической НВГ кровоизлияния в отростки ЦТ встречались в 5,3 раза чаще, в 23 раза чаще выявлялось новообразование сосудов стекловидного тела и в 26,3 раза чаще определялись фиброзные витреоретинальные шварты.Выявленные в обеих группах значительно расширенные перивазальные щели в ЦТ, РО, хориоидее и сетчатой оболочке (СО), значительно расширенные каналоподобные образования между мышечными волокнами ЦТ и РО, кистоподобные образования в СО могут быть расценены как результат перегруженности прелимфатических путей оттока тканевой жидкости из структур глаза.Выводы. Совокупность морфологических проявлений свидетельствует о том, что у пациентов с терминальной НВГ диабетического генеза, по сравнению с посттромботической НВГ, значительно более выраженной является воспалительная реакция, кровоточивость сосудистой стенки и более выражена склонность к избыточной пролиферации сосудов и соединительнойткани. Полученные данные обосновывают ожидаемые осложнения в зоне потенциального хирургического вмешательства и патогенетически направленные фармакотерапевтические воздействия для оптимизации комплексного лечения при НВГ различного происхождения. Purpose. To determine the similarities and differences in morphological changes in the choroid and retina of the eye with terminal pain neovascular glaucoma of post-thrombotic and diabetic genesis. Materials and methods. 57 enucleated eyeballs (344 preparations) were studied: group 1 – 156 preparations of 26 enucleated eyeballs with NVG developed due to thrombosis of the central retinal vein (CRV) or its branches in patients with arterial hypertension; group 2 – 188 drugs from 31 eyes with NVG developed in patients with diabetes mellitus (DM) with proliferative diabetic retinopathy (PDR). Histological sections were stained with hematoxylin and eosin, and according to Van Gieson. 5–6 sections of each eyeball were analyzed using an Olimpus BX-41 microscope with a magnification of x 200–400.Results and discussion. Morphologically revealed generalized microthrombosis in the tissues ofenucleated eyes with NVG of postocclusal origin, in contrast to eyes with NVG on the background of DM. Revealed significantly expanded perivasal gaps in the ciliary body (CB), iris, choroid and retina, significantly expanded canal-like formations between the muscle fibers of CB and iris, cyst- like formations in retina can be regarded as a result of congestion of the prelimphatic pathways of the outflow of tissue fluid from the structures of the eye. In the group with post-thrombotic NVG, in contrast to the group with diabetic NVG, blood clots in the vessels of the CB were 4.1 times more common, blood clots in the vessels of the iris were 4 times more common, 4 8 times more often – in the vessels of the choroid. In the group with NVG on the background of DM, in contrast to the group with post-thrombotic NVG hemorrhages in the processes of the CB were 5.3 more often, 23 times more often a neoplasm of the vessels of the vitreous body was detected and fibrous vitreoretinal moorings were determined 26.3 times more often.Conclusions. The combination of morphological manifestations suggests that in patients with diabetic genesis of terminal NVG, in comparison with post-thrombotic NVG, the inflammatory reaction is more pronounced, bleeding of the vascular wall and more pronounced tendency to hyperproliferation of blood vessels and connective tissue. The data obtained justify the expected complications in the area of potential surgical intervention and pathogenetically directed pharmacotherapeutic effects to optimize the complex treatment of NVG of various origins.
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Moore, Dustin, and Jesse Morrell. "Do Dietary Patterns Differ with Video Game Usage in College Men?" Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1334. http://dx.doi.org/10.1093/cdn/nzaa059_051.
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Abstract Objectives To assess the differences in fruit and vegetable (F/V), total dietary fat, saturated fat, sodium, sugar, and discretionary calorie consumption, as well as body fat percentage (BF%), body mass index (BMI), and iliac crest waist circumference (WC) between high, moderate, and non-video game users in a sample of male college students. Methods Data collected between 2012–2018 from the College Health and Nutrition Assessment Survey, an ongoing cross-sectional study at a public New England university, were analyzed. After exclusion of participants with missing data, our final sample sizes were n = 1095, n = 1060, and n = 786 for diet, BF%, and BMI/WC analyses, respectively. Daily video game usage (hrs/day) was self-reported and categorized as: non-users (NVG), <1hr/day users (MVG), and ≥1hr/day (HVG). BF% was measured via bioelectrical impedance; BMI and WC were measured in duplicate. Food and nutrient data were obtained from three-day food records. Group differences were examined via ANCOVA using total kilocalories, daily steps, and first-year status as covariates. Results College men reported varying levels of video game usage: 30.5% reported NVG, 39.4% reported MVG, and 30.1% reported HVG. Higher WC was observed in MVG compared to NVG (84.5 ± 0.5 cm vs. 82.4 ± 0.6 cm, P < 0.02); no differences in WC were seen between HVG vs. NVG (84.0 ± 0.6 cm vs. 82.4 ± 0.6 cm, P = 0.18). BMI and BF% did not differ between groups. Higher saturated fat consumption (30.1 ± 0.4 g and 29.9 ± 0.4 g, vs. 28.2 ± 0.4 g, P < 0.002, P < 0.02) and lower F/V consumption (2.96 ± 0.1 cups and 3.01 ± 0.1 cups, vs. 3.43 ± 0.1 cups, P < 0.001, P < 0.01) were observed in MVG and HVG vs. NVG. Sodium intake was higher in MVG vs. NVG (3957 ± 46 mg vs. 3701 ± 53 mg, P < 0.001) while discretionary calories were higher in HVG vs. NVG (759 ± 14 kcals vs. 693 ± 14 kcals, P < 0.003). No differences in total dietary fat, sugar, or alcohol consumption between groups were found. Conclusions Video game usage was associated with higher WC, saturated fat, sodium, discretionary calories, and lower F/V intake in college men. This knowledge can help to tailor nutrition education to male students; however, more robust, experimental studies in the college population are needed to confirm our observations. Funding Sources The New Hampshire Agriculture Experiment Station and the USDA National Institute of Food and Agriculture Hatch Project 1010,738.
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Asif, Hassaan, Zhuangjun Si, Steven Quan, Pathik Amin, David Dao, Lincoln Shaw, Dimitra Skondra, and Mary Qiu. "Neovascular Glaucoma from Ocular Ischemic Syndrome Treated with Serial Monthly Intravitreal Bevacizumab and Panretinal Photocoagulation: A Case Report." Case Reports in Ophthalmological Medicine 2022 (July 28, 2022): 1–5. http://dx.doi.org/10.1155/2022/4959522.
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Purpose. To describe a case of open-angle neovascular glaucoma (NVG) secondary to ocular ischemic syndrome (OIS) treated with a planned series of 6 monthly anti-VEGF injections with interspersed panretinal photocoagulation (PRP) sessions. We term this treatment protocol the Salvaging Conventional Outflow Pathway in Neovascular Glaucoma (SCOPING) Protocol, and this is our (MQ and DS) standard of care for all NVG patients presenting with partially or completely open angles. Case. A 66-year-old man’s right eye had a visual acuity of 20/50, intraocular pressure (IOP) of 42 mmHg on 0 IOP-lowering medications, and neovascularization of the iris and angle with no peripheral anterior synechiae. Fundoscopy revealed midperipheral dot-blot hemorrhages without diabetic retinopathy or vein occlusion. Fluorescein angiography revealed peripheral retinal nonperfusion in both eyes. The patient was diagnosed with open-angle NVG secondary to OIS and treated with 6 serial monthly anti-VEGF injections interspersed with 4 PRP sessions, after which his anterior segment neovascularization regressed and IOP normalized on 0 medications. Ten weeks after the last injection, the anterior segment neovascularization and elevated IOP recurred, so he underwent 4 more monthly anti-VEGF injections and 4 PRP sessions, after which his anterior segment neovascularization regressed and his IOP normalized on 0 medications. However, 6 weeks after the last injection, the anterior segment neovascularization and elevated IOP again recurred, so he was resumed on a third course of lifetime monthly anti-VEGF injections, which may be continued in perpetuity. Conclusion. The patient’s NVG was quiescent while under the protection of serial anti-VEGF injections with interspersed PRP; however, the disease recurred each time injections were stopped. Therefore, in patients with open-angle NVG secondary to OIS, serial monthly anti-VEGF injections may be necessary combined with PRP to suppress underlying neovascular drive and regress anterior segment neovascularization, maintain physiologic IOP, and prevent synechial angle closure.
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Ishizuka, Erdal Tan, Atsuhiro Kanda, Yasuhiro Shinmei, Takeshi Ohguchi, Yoshiaki Tagawa, Keitaro Hase, Taku Yamamoto, Kousuke Noda, Shinki Chin, and Susumu Ishida. "Receptor-Associated Prorenin System in the Trabecular Meshwork of Patients with Primary Open-Angle Glaucoma and Neovascular Glaucoma." Journal of Clinical Medicine 9, no. 8 (July 22, 2020): 2336. http://dx.doi.org/10.3390/jcm9082336.
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The receptor-associated prorenin system (RAPS) is associated with several pathologic conditions, including diabetic retinopathy, age-related macular degeneration, and uveitis. Here, we show the involvement of RAPS in the trabecular meshwork (TM) from patients with primary open-angle glaucoma (POAG) and neovascular glaucoma (NVG) due to proliferative diabetic retinopathy. Anterior chamber (AC) levels of prorenin significantly increased in both POAG and NVG, as did those of angiotensin II in NVG alone, compared to cataract. In surgically excised TM tissues, (pro)renin receptor ((P)RR) and angiotensin II type 1 receptor (AT1R) co-localized with prorenin and angiotensinogen, respectively. In screening for various genes related to glaucoma, prorenin stimulation to human TM cells exclusively upregulated cell junction constituents connexin 43 and zona occludens 1, while downregulating an extracellular matrix-degrading enzyme tissue plasminogen activator, all of which were reversed by (P)RR blockade. In contrast, angiotensin II application upregulated a pro-angiogenic factor placental growth factor alone, which was abolished by AT1R blockade. Consistently, (P)RR and AT1R co-localized with these corresponding proteins in patient TM tissues. Oxidative stress, a known etiology for glaucoma, induced the expression of prorenin and angiotensinogen in human TM cells. These data suggest the contribution of RAPS to the molecular pathogenesis of POAG and NVG through TM tissue remodeling and AC angle angiogenesis.
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Venkat, Arthi G., Rishi P. Singh, Jonathan Eisengart, Ming Hu, and Amy S. Babiuch. "Trends in neovascular glaucoma management: Practice patterns of glaucoma and retina specialists in the United States." American Journal of Ophthalmic Clinical Trials 2 (December 4, 2019): 7. http://dx.doi.org/10.25259/ajoct_11_2019.
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Purpose: To characterize practice patterns between and within retina and glaucoma subspecialists treating neo- vascular glaucoma (NVG). Methods: Preliminary survey study consisting of 8-questions developed based on actual clinical cases presenting to our institution between June 2014 and June 2016. The survey was administered in the form of clinical vignettes and circulated electronically using Survey Monkey ©. to members of the American Glaucoma Society (AGS) and American Society of Retina Specialists (ASRS). Results: 109 glaucoma and 130 retina specialists initiated the survey. For initial management of patients with good visual acuity (VA) and NVG, retina specialists preferred anti-VEGF therapy (P < 0.01) while glaucoma specialists preferred combined anti-VEGF and tube shunt surgery (P < 0.01). Following initial therapy in patients with good VA, glaucoma specialists preferred surgery (P < 0.01) and retina specialists preferred PRP (P < 0.01). In patients with poor VA, PRP and anti-VEGF were equally favored, with a preference for surgery by glaucoma specialists compared to retina specialists (P < 0.01). Conclusion: NVG is a complex problem within the field of ophthalmology that often requires management by both retina and glaucoma specialists. Agreement between both subspecialties for the use of anti-VEGF agents as first line treatment, either alone or in concert with other therapies was noted. Multiple differences exist in next step in therapy and long-term management. Future consensus panels may mitigate discrepancies in NVG management and work toward development of care paths for more efficient care delivery.
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Toebe, Marcos, Cirineu Tolfo Bandeira, Sabrina Kitina Giordano Fortes, Juliana Oliveira de Carvalho, Francieli de Lima Tartaglia, André Limana Tambara, and Patricia Jesus de Melo. "Dimensionamento amostral e associação linear entre caracteres de Crotalaria spectabilis." Bragantia 76, no. 1 (January 12, 2017): 45–53. http://dx.doi.org/10.1590/1678-4499.653.
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RESUMO Os objetivos deste trabalho foram determinar o tamanho de amostra necessário para a estimação da média de caracteres e avaliar as relações lineares existentes entre caracteres de plantas de Crotalaria spectabilis. Foi conduzido um experimento com C. spectabilis na safra 2014/2015, sendo os seguintes caracteres avaliados em 100 plantas: altura da planta (AP), número de ramos produtivos (NRP), massa seca da parte aérea (MSPA), massa seca de vagens (MSVG), número de vagens (NVG), peso médio de cada vagem (PMVG), número de sementes (NS), número médio de sementes por vagem (NSVG), massa de cem grãos (MCG) e peso total de sementes (PTS). Foram calculadas medidas de tendência central, de dispersão e de distribuição, foi verificada a normalidade dos dados e determinado o tamanho de amostra necessário para a estimação da média de cada caractere, assumindo-se erros de estimação iguais a 1, 2, …, 20% da média. Depois, foram calculados os coeficientes de correlação linear de Pearson e estimados os efeitos diretos e indiretos das variáveis explicativas sobre PTS por meio de análise de trilha. Em C. spectabilis, são necessárias 121 plantas para estimação da média dos caracteres NRP, MSPA, MSVG, NVG, NS e PTS com erro máximo de 10% da média. Já para a estimação da média de AP, PMVG, NSVG e MCG nesse mesmo nível de precisão, são necessárias 6 plantas. A variável NS apresentou elevada correlação e efeito direto sobre PTS, indicando relação de causa e efeito e possibilidade de seleção indireta. As demais variáveis explicativas apresentaram efeitos indiretos sobre PTS via NS.
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Bai, Ling, Yi-Dan He, Shu Zhang, and Feng Wang. "Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade." International Journal of Ophthalmology 14, no. 3 (March 18, 2021): 456–60. http://dx.doi.org/10.18240/ijo.2021.03.20.
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AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma (NVG) after vitrectomy with silicone oil tamponade. METHODS: Conbercept 0.5 mg/0.05 mL was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation (PRP) or extra-PRP were conducted within 2d. The follow-up time was 6mo. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), neovascularization of iris (NVI) were recorded before and after treatment. RESULTS: Within 2d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.
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Shen, Xi, Yanwei Chen, Yanuo Wang, Lu Yang, and Yisheng Zhong. "Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy." Journal of Ophthalmology 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/4108490.
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Purpose.To determine the efficacy of intravitreal ranibizumab injection as adjuvant therapy in the treatment of neovascular glaucoma (NVG) accompanied by postvitrectomy diabetic vitreous hemorrhage (PDVH).Methods.Eighteen NVG patients (18 eyes) accompanied by PDVH were enrolled in this prospective, monocenter, 12-month, interventional case series. The consecutive 18 patients with an IOP ≥ 25 mmHg despite being treated with the maximum medical therapy were treated with intravitreal ranibizumab injections. Vitreous surgery or/with Ahmed valve implantation were indicated if no clinical improvement in vitreous haemorrhage and uncontrolled IOP was shown.Results.Ten patients got clear vitreous and controlled IOP only with2.7±1.8injections of ranibizumab without additional surgery. Vitrectomy or/with Ahmed valve implantation was administered in the other 8 eyes due to uncontrolled VH and IOP. At follow-up month 12, all the 18 eyes gained clear vitreous. At month 12 BCVA improved significantly compared to baseline. The baseline and follow-up at month 12 IOP/medication usage were36.7±8.1 mmHg on3.4±0.7medications and16.2±4.9 mmHg on0.67±0.77medications, respectively.Conclusions.The findings suggest that intravitreal ranibizumab injection as adjuvant therapy for treatment of NVG accompanied by PDVH may be safe and potentially effective. This clinical trial is registered withNCT02647515.
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Wagdy, Faried Mohammed, and Adel Galal Zaky. "Comparison between the Express Implant and Transscleral Diode Laser in Neovascular Glaucoma." Journal of Ophthalmology 2020 (May 18, 2020): 1–6. http://dx.doi.org/10.1155/2020/3781249.
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Purpose. To compare the outcomes of Ex-PRESS glaucoma filtration device and transscleral cyclophotocoagulation (TSCP) in the management of neovascular glaucoma (NVG). Patients and Methods. A total of 30 eyes (12 express shunts and 18 TSCP) of 28 patients were included. The eyes had NVG with intraocular pressure (IOP) more than 21 mmHg of the maximally tolerated medication treatment after previous panretinal photocoagulation and antivascular endothelial growth factor (anti-VEGF) injection, with no previous history of a cyclodestruction procedure or glaucoma surgery, were randomized either for Ex-PRESS glaucoma filtration device or TSCP. The patients were followed up weekly for the first month and then monthly for 12 months as regard to the IOP, number of topical antiglaucoma drugs required, visual outcome, and postoperative complications. Results. IOP was successfully controlled with both techniques in 83.3% of the eyes. Both techniques had fewer complications and required fewer subsequent procedures. Conclusion. Both the Ex-PRESS glaucoma filtration device and TSCP might constitute safe and alternative therapeutic tools for patients with NVG. However, TSCP is an easier procedure, less time consuming, and does not require a learning curve.
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Barrett, Jeff M., Colin D. McKinnon, Clark R. Dickerson, Andrew C. Laing, and Jack P. Callaghan. "Posture and Helmet Configuration Effects on Joint Reaction Loads in the Middle Cervical Spine." Aerospace Medicine and Human Performance 93, no. 5 (May 1, 2022): 458–66. http://dx.doi.org/10.3357/amhp.5830.2022.
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INTRODUCTION: Between 43 and 97% of helicopter pilots in the Canadian Armed Forces report neck pain. Potential contributing factors include the weight of their helmet, night vision goggles (NVG), and counterweight (CW) combined with deviated neck postures. Therefore, the purpose of this investigation was to quantify changes in neck loads associated with posture, helmet, NVG, and CW.METHODS: Eight male subjects volunteered. They undertook one of five deviated neck postures (flexion, extension, lateral bending, axial rotation) times four configurations (no helmet, helmet only, helmet and NVG, and helmet, NVG, and CW). 3D kinematics and EMG from 10 muscles (5 bilaterally) drove a 3D inverse dynamics, EMG-driven model of the cervical spine which calculated joint compression and shear at C5-C6.RESULTS: The compression in the neutral posture was 116.5 (5.7) N, which increased to 143.7 (11.4) N due to a 12.7 N helmet. NVGs, weighing 7.9 N, also generated this disproportionate increase, where the compression was 164.2 (3.7) N. In flexion or extension, the compression increased with increasing head-supported mass, with a maximum of 315.8 (67.5) N with the CW in flexion. Anteroposterior shear was highest in the lateral bending [34.0 (6.2) N] condition, but was generally low (< 30 N). Mediolateral shear was less than 5 N for all conditions.DISCUSSION: Repositioning the center of gravity of the helmet with either NVGs or CW resulted in posture-specific changes to loading. Posture demonstrated a greater potential to reposition the head segment’s center of gravity compared to the helmet design. Therefore, helmet designs which consider repositioning the center of gravity may reduce loads in one posture, but likely exacerbate loading in other postures.Barrett JM, McKinnon CD, Dickerson CR, Laing AC, Callaghan JP. Posture and helmet configuration effects on joint reaction loads in the middle cervical spine. Aerosp Med Hum Perform. 2022; 93(5):458–466.
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Hanna, Rana, Beatrice Tiosano, Shmuel Graffi, and Dan Gaton. "Clinical Efficacy and Safety of the EX-PRESS Filtration Device in Patients with Advanced Neovascular Glaucoma and Proliferative Diabetic Retinopathy." Case Reports in Ophthalmology 9, no. 1 (January 23, 2018): 67–75. http://dx.doi.org/10.1159/000479363.
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Background: The prognosis of conventional filtration surgery in eyes with neovascular glaucoma (NVG) is limited due to increased fibrovascular proliferation or bleeding. This study aims to evaluate the safety and efficacy of the EX-PRESS filtration device in the management of NVG associated with proliferative diabetic retinopathy (PDR). Methods: In this retrospective case series, we reviewed the medical records of patients diagnosed as having NVG associated with PDR who underwent EX-PRESS filtration surgery. The main outcome measures were: postoperative intraocular pressure (IOP), the percent of IOP drop, the number of glaucoma medications, visual acuity, and complications of surgery. Successful surgery was defined as an IOP <22 mm Hg and >5 mm Hg with or without additional glaucoma surgery, and no loss of light perception or less than a 2-line decrease on the Snellen chart of the best corrected visual acuity (BCVA). Results: Five patients (5 eyes) were included in this study. The mean preoperative IOP was 33.4 ± 5.9 mm Hg compared to an IOP of 17.0 ± 3.0 mm Hg at the last follow-up (p = 0.003). The mean number of preoperative anti-glaucoma medications was 3.8 ± 0.4 compared to 2.2 ± 1.5 (p = 0.06) at the last follow-up visit. Final visual acuity improved or stabilized within 1 Snellen line in all 5 patients. Three patients had a “hypertensive phase” (defined as an IOP >21 mm Hg during the first 6 postoperative months) which resolved within 2 months. Two patients developed a hyphema that resolved spontaneously. None of the patients experienced any serious complications. Conclusion: EX-PRESS filtration device has a good IOP-lowering effect and a low rate of complications in patients with advanced NVG associated with PDR. In addition, there was no loss of light perception or no line decrease of the BCVA.
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Maki, Hitomi, Sotaro Mori, Hisanori Imai, Hiroko Yamada, Keiko Otsuka, Akiko Miki, Sentaro Kusuhara, and Makoto Nakamura. "Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma." Journal of Clinical Medicine 10, no. 8 (April 10, 2021): 1606. http://dx.doi.org/10.3390/jcm10081606.
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Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for refractory glaucoma. The new autologous scleral pocket technique is performed by inserting the tube into the vitreous cavity without using a donor scleral patch. The purpose of this study was to evaluate the surgical results of Ahmed glaucoma valve (AGV) implantation using this technique for neovascular glaucoma (NVG), which is one of the representative refractory types of glaucoma. This observational retrospective case series included 15 consecutive eyes of 15 patients with NVG who had undergone AGV implantation at Kobe University between January 2018 and December 2019. The mean preoperative intraocular pressure (IOP) was 37.2 ± 13.8 mmHg and the glaucoma drug score was 4.2 ± 2.2. The mean IOP and glaucoma drug score at 1 year postoperatively decreased to 15.0 ± 4.6 mmHg and 1.3 ± 2.0, respectively (p < 0.001). No significant change in the corneal endothelial cell density following surgery was observed (p = 0.09); however, one patient required an additional trabeculectomy at 7 months postoperatively. No cases of tube exposure or conjunctival erosion were observed at 1 year postoperatively. These results indicated the effectiveness and safety of this technique in patients with NVG.
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TSENG, C. Y., C. H. CHEN, S. C. SU, F. T. WU, C. C. CHEN, G. Y. HSIEH, C. H. HUNG, and C. P. FUNG. "Characteristics of norovirus gastroenteritis outbreaks in a psychiatric centre." Epidemiology and Infection 139, no. 2 (March 25, 2010): 275–85. http://dx.doi.org/10.1017/s0950268810000634.
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SUMMARYNoroviruses are an important aetiological agent of acute gastroenteritis. They are responsible for large outbreaks of disease in the community, hospitals and long-term-care facilities. The clinical manifestations of norovirus outbreaks in psychiatric units are rarely described. The disease burden and impact highlight the importance of timely notification and investigation of these outbreaks. We analysed the characteristics of four norovirus outbreaks which occurred during a 3-year period in an in-patient psychiatric care unit. A total of 184 patients were affected which included 172 hospitalized patients, seven healthcare workers (HCWs) and five psychiatric nursing-home residents. The mean incidence rate of norovirus gastroenteritis (NVG) in hospitalized patients during these outbreaks was 12·7%. These outbreaks were characterized by higher incidence in middle-aged male patients, predominant sickness of diarrhoea, short duration of illness, peaks in late winter and early spring, and higher susceptibility in acute psychiatric patients. HCWs had longer duration of illness than psychiatric patients. More than 10% of affected patients experienced ⩾2 infections. Infection control measures were instituted and a comprehensive, responsive standard operating procedure for NVG and outbreak management was developed. After implementation of these measures, no further outbreaks of NVG occurred during the study period.
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Kwon, Junki, and Kyung Rim Sung. "Effect of Preoperative Intravitreal Bevacizumab on the Surgical Outcome of Neovascular Glaucoma at Different Stages." Journal of Ophthalmology 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/7672485.
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Purpose. To evaluate the effect of preoperative intravitreal bevacizumab (IVB) injection on the surgical outcome of Ahmed glaucoma valve (AGV) implantation according to the angle status in neovascular glaucoma (NVG) eyes. Materials and Methods. This retrospective study included 70 NVG patients who underwent AGV implantation and were followed up for at least 12 months. An IVB injection before AGV implantation was administered to 45 eyes (IVB group), while it was not administered to 25 eyes (control group). Subgroup analyses were done at different stages in terms of the extent of peripheral anterior synechiae (PAS). Results. Mean follow-up period after AGV implantation was 27 ± 15 months. The IVB group showed higher prevalence of the eyes with less than 50% of PAS than that of the control group (78% versus 44%). The overall success rate 1 year postoperatively was 80% and 64% for the IVB and control groups, respectively (P=0.142). When PAS extent was less than 50%, preoperative IVB had a marginally positive effect on surgical outcome (HR = 0.39, P=0.064, per 1-time IVB injection). Conclusions. Preoperative IVB may enhance the success rate of AGV implantation in NVG eyes, before PAS has extensively formed. Further prospective randomized studies controlling the extent of PAS are warranted.
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Gadde, Santosh Gopi Krishna, Akhila Sridharan, Nikitha Gurram Reddy, and Chaitra Jayadev. "Neovascular glaucoma following Nd:YAG laser capsulotomy: a rare complication in a postvitrectomised patient with diabetes." BMJ Case Reports 15, no. 4 (April 2022): e249264. http://dx.doi.org/10.1136/bcr-2022-249264.
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To describe a case of acute-onset neovascular glaucoma (NVG) after a neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy in a diabetic vitrectomized eye of a patient with severe systemic and ocular comorbidities. A man in his 50s underwent a Nd:YAG capsulotomy for visually significant posterior capsular opacification with a previous history of vitrectomy with silicone oil in situ for diabetic retinopathy. He had systemic and ocular comorbidities implicating an advanced ischaemic status, both systemically and locally. Five days post Nd:YAG capsulotomy, extensive neovascularisation of the iris and angles was noted. Despite maximum antiglaucoma medication, an evisceration ensued due to intractable NVG. This case report highlights the importance of irreversible complications after a seemingly simple capsulotomy in eyes with advanced ocular conditions and systemic comorbidities necessitating extreme caution.
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Zhao, Xuli, and Yakun Wang. "Prognostic Evaluation of Vitrectomy Assisted by Lucentis in Diabetic Retinopathy and Neovascular Glaucoma." Evidence-Based Complementary and Alternative Medicine 2022 (August 1, 2022): 1–6. http://dx.doi.org/10.1155/2022/4127293.
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For verifying the prognosis of Lucentis-assisted vitrectomy (PPV) in diabetic retinopathy (DR) and neovascular glaucoma (NVG), a retrospective analysis of DR and NVG patients who were admitted to our hospital from July 2019 to December 2020 was conducted. According to the treatment protocol, subjects who had PPV intervention were in the control group (CG; n = 38) and those receiving Lucentis adjunctive PPV were included in the intervention group (RG; n = 40). The indicators between groups were listed: treatment success rate, postoperative complication rate, surgical outcome indicators, BCVA, intraocular pressure (IOP) change, foveal thickness, and VEGF level in aqueous humor. Indicators in RG were obviously higher than in CG, such as treatment success rate and surgical outcome indicators. Conversely, lower postoperative complication rate, postoperative BCVA, IOP, retinal fovea thickness, and VEGF level in aqueous humor were found in RG than in CG. Therefore, the study reached the following conclusions about vitrectomy assisted by Lucentis: (1) it effectively increases the success rate of treatment, decreases postoperative complications as well as surgical risks, and improves patients’ vision; (2) it promotes the recovery of IOP, reduces macular edema and VEGF levels in aqueous humor, and inhibits the neonatal formation of blood vessels. It is finally confirmed that Lucentis adjuvant PPV in the treatment of DR complicated with NVG is safe and feasible.
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Strzalkowski, Piotr, Alicja Strzalkowska, Winfried Göbel, Nils A. Loewen, and Jost Hillenkamp. "Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series." F1000Research 9 (March 2, 2021): 1236. http://dx.doi.org/10.12688/f1000research.26879.2.
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Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.
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Strzalkowski, Piotr, Alicja Strzalkowska, Winfried Göbel, Nils A. Loewen, and Jost Hillenkamp. "Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series." F1000Research 9 (October 14, 2020): 1236. http://dx.doi.org/10.12688/f1000research.26879.1.
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Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.
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Marjanovic, Ivan, Marjan Marjanovic, Ranko Gvozdenovic, Marija Marjanovic, Vujica Markovic, Marija Bozic, Vesna Maric, and Antonio Martinez. "Pre-trabeculectomy intravitreal injections of Bevacizumab for treating neovascular glaucoma in diabetic patients." Vojnosanitetski pregled 77, no. 6 (2020): 637–40. http://dx.doi.org/10.2298/vsp170531137m.
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Background/Aim. Neovascular glaucoma (NVG) is a secondary glaucoma caused by occlusion of the trabecular network of newly formed blood vessels. The aim of this study was to evaluate the efficacy and safety of intravitreal injections of bevacizumab before trabeculectomy with mitomycin C (MMC) for the treatment of NVG. Methods. A prospective and open-label study was conducted from May 2013 to December 2014 on consecutive NVG patients who underwent intravitreal injections of bevacizumab and a primary trabeculectomy with MMC. All patients were followed-up at least for 12 months. Success was defined as an intraocular pressure (IOP) of ? 21 mm Hg with or without topical ocular hypotensive medication. Results. Fourteen eyes of 12 diabetic patients fulfilled the respective demands of the inclusion and exclusion criteria. The mean (? standard deviation) follow-up period was 15.0 (? 2.0) months (range, 12 to 19 months). After one year of follow-up, 11 (78.6%) eyes had an IOP ? 21 mmHg. The mean IOP was significantly reduced from 42.4 (? 9.7) mmHg preoperatively to 18.4 (? 2.9) mmHg postoperatively (p < 0.0001). Regarding surgical complications, 6 months of trabeculectomy, hyphaema was observed in 3 (21.4%) eyes, macular edema in one (7.1%) eye and recurrence of neovascularization requiring intravitreal bevacizumab injection in 2 (14.2%) eyes. Conclusion. Preoperative intravitreal bevacizumab may be effective as adjunctive treatment for trabeculectomy with mitomycin-C for neovascular glaucoma patients.
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Yan, Hua. "Outcomes of 23-Gauge Vitrectomy Combined with Phacoemulsification, Panretinal Photocoagulation, and Trabeculectomy without Use of Anti-VEGF Agents for Neovascular Glaucoma with Vitreous Hemorrhage." Journal of Ophthalmology 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/3097379.
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Purpose. To evaluate the outcomes of 23-gauge vitrectomy combined with phacoemulsification, PRP and trabeculectomy without use of anti-VEGF-agents for NVG. Methods. Eighteen eyes of 18 patients with NVG underwent 23-gauge vitrectomy combined with phacoemulsification, PRP and trabeculectomy without use of anti-VEGF agents. The preoperative BCVA ranged from light perception to 0.2. The preoperative IOP ranged from 38 mmHg to 64 mmHg with a mean of 54±8 mmHg. The average follow-up time was 14.5±3 months with a range from 11 to 24 months. Results. The postoperative VA increased in 14 eyes and was stable in 4 eyes at the final follow-up. The mean IOP was 12±3 mmHg at postoperative day 1. The mean IOP was 15±2 mmHg, 16±3 mmHg, 23±5 mmHg, 28±4 mmHg, 22±5 mmHg, 17±3 mmHg, and 19±4 mmHg at postoperative days 2 and 3, 1, 2, 3, and 12 weeks, and 1 year postoperatively, respectively, with a range from 10 to 30 mmHg at the final follow-up time point of one year. The IOP was significantly lower than the preoperative one 12 weeks postoperatively (p<0.05). Conclusion. 23-gauge vitrectomy combined with phacoemulsification, PRP, and trabeculectomy without use of anti-VEGF-agents is a safe and effective method in treating NVG.
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Takayama, Kei, Hideaki Someya, Hiroshi Yokoyama, Takeshi Kimura, Yoshihiro Takamura, Masakazu Morioka, Hiroto Terasaki, et al. "Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy." PLOS ONE 16, no. 10 (October 8, 2021): e0258415. http://dx.doi.org/10.1371/journal.pone.0258415.
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Purpose Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigated factors related to the potential bias of retinal surgeons in using IVI prior to vitrectomy for PDR-related complications, and evaluated the real-world outcomes of surgeon-determined preoperative IVI. Methods Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications. Results At baseline, IVI group was younger (P<0.001), had shorter duration of diabetes treatment (P = 0.045), and higher frequencies of neovascular glaucoma [NVG] (P<0.001) and tractional retinal detachment [TRD] (P<0.001) compared to non-IVI group. Although IVI group had higher frequencies of intraoperative retinal break and tamponade procedure, there were no significant differences in postoperative complications and additional treatments between two groups. Baseline HbA1c levels were also not correlated with postoperative complications of VH, NVG, and RD both in IVI group and non-IVI group. Logistic regression analysis identified age (P<0.001, odds ratio [OR] 0.95), presence of NVG (P<0.001, OR 20.2), and presence of TRD (P = 0.0014, OR 2.44) as preoperative factors in favor of IVI. Conclusions In this multicenter real-world clinical study, younger age and presence of NVG and TRD were identified as potential biases in using IVI before vitrectomy for PDR complications. Eyes that received preoperative IVI had more intraoperative retinal breaks requiring tamponade than eyes not receiving IVI, but postoperative outcome was not different between the two groups.