Treatment Choice in Neovascular Glaucoma: Pars Plana Vitrectomy First, Followed by Ahmed Glaucoma Valve Implantation, or Both Simultaneously?

Purpose To compare the long-term surgical success rates, clinical outcomes and complications of simultaneous pars plana vitrectomy (PPV) and Ahmed glaucoma valve (AGV) implantation versus AGV implantation performed after PPV in eyes with neovascular glaucoma (NVG) and intractable intraocular pressure (IOP).Methods This retrospective study evaluated 39 eyes of 39 NVG patients who were divided into two groups: those treated with combined PPV and AGV implantation (Group 1, n = 18) and those treated with AGV implantation after PPV (Group 2, n = 21). Complete success was defined as postoperative IOP of 5–21 mmHg without antiglaucoma medication (AGM); qualified success was defined as postoperative IOP in the same range with or without AGM.Results Preoperative characteristics were similar between the groups. The median baseline IOP was 37.0 (32.8–45.3) mmHg in Group 1 and 36.0 (29.5–44.0) mmHg in Group 2 (p = .813). Group 1 showed significantly lower median IOP at postoperative day 1 (18.0 vs. 20.0 mmHg, p = .035) and week 2 (11.5 vs. 18.5 mmHg, p = .043) compared with Group 2. At the final visit, IOP levels were comparable (14.0 vs. 15.0 mmHg, p = .944). Hyphema was more frequent in Group 1 (50%) than in Group 2 (14.3%) in the early postoperative period. Long-term surgical success rates for complete success (p = .209) and qualified success (p = .521) did not significantly differ between the groups. At 5 years, qualified success rates were 77.1% for Group 1 and 75.0% for Group 2.Conclusion Both simultaneous and sequential approaches are safe and effective, offering comparable long-term success for NVG management. The simultaneous approach provides faster initial IOP control and reduces surgical burden. Despite higher early transient inflammation, long-term IOP control or surgical success remains uncompromised.