Management of Stage IV Neovascular Glaucoma in Proliferative Diabetic Retinopathy with Single Step Pars Plana Vitrectomy + Endolaser + Trabeculectomy + Mitomycin C Versus 2-Step Approach, i.e., Pan Retinal Photocoagulation Followed by Trabeculectomy + Mitomycin C

Purpose: To compare the success between single-step pars plana vitrectomy (PPV) + Endolaser (EL) + Trabeculectomy + mitomycin C (MMC) and 2-step approach, i.e., pan-retinal photocoagulation (PRP) followed by Trabeculectomy + MMC in cases of stage IV neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR). Methods: Prospective, interventional study including 16 eyes of 16 patients with stage 4 NVG in cases of PDR between July 2019 and December 2020. Depending on the type of surgery, patients were divided into two groups. Group I: PRP followed by Trabeculectomy + MMC ( n = 8), Group II: Combined PPV + EL + Trabeculectomy + MMC ( n = 8). All patients received intravitreal bevacizumab 3 days before the surgery in both groups. Success criteria were postoperative intraocular pressure (IOP) of <20 mm Hg with or without antiglaucoma medication. Results: Postoperative IOP decreased significantly in both groups, but the mean IOP after 6 months was lower in combined group (17 mm Hg) than trabeculectomy group (22.25 mm Hg; P = 0.204). Combined group required fewer anti-glaucoma medications (mean: 0.88) than trabeculectomy group (mean: 1.38). Cumulative surgical success rates for combined group and Trabeculectomy groups were 100% and 75% respectively. No significant differences in intraoperative complications were observed between the groups. Conclusion: In stage 4, NVG secondary to PDR, single step combined approach including PPV + EL + Trabeculectomy + MMC could be more effective in controlling IOP with better visual outcome than Trabeculectomy + MMC.