Neovascular glaucoma: a review

Area of Science:

• Ophthalmology
• Vascular Biology
• Glaucoma Research

Background:

• Neovascular glaucoma (NVG) is a secondary glaucoma with a poor visual prognosis.
• It results from new blood vessel growth (neovascularization) on the iris and iridocorneal angle, obstructing aqueous humor outflow and increasing intraocular pressure.
• NVG is typically caused by posterior segment ischemia, often linked to proliferative diabetic retinopathy or central retinal vein occlusion.

Approach:

• Diagnosis involves slit lamp examination of the iris, iridocorneal angle, and retina to detect neovascularization.
• Understanding the role of angiogenic factors like vascular endothelial growth factor (VEGF) and anti-angiogenic factors is key.
• Treatment strategies have evolved from traditional panretinal photocoagulation to newer approaches.

Key Points:

• Neovascularization is driven by an imbalance between pro-angiogenic and anti-angiogenic factors.
• Early detection can prevent goniosynechia and subsequent intraocular pressure elevation.
• Intravitreal anti-VEGF therapies are increasingly investigated for NVG management.

Conclusions:

• NVG management requires addressing the underlying ischemic cause and controlling intraocular pressure.
• While panretinal photocoagulation was historical standard, anti-VEGF therapies offer a promising alternative.
• Medical management with hypotensive drops, laser, and surgical procedures are employed based on severity.