Cyclophotocoagulation in Neovascular Glaucoma with Near-Total Synechial Angle Closure

Area of Science:

• Ophthalmology
• Glaucoma Research
• Vascular Biology

Background:

• Neovascular glaucoma (NVG) presents a significant challenge due to active anterior segment neovascularization and synechial angle closure, leading to uncontrolled intraocular pressure (IOP).
• Prompt intervention is crucial to prevent irreversible vision loss in NVG eyes.

Observation:

• A retrospective chart review examined eight NVG patients with near-total synechial angle closure and active anterior segment neovascularization.
• All patients received prompt transscleral cyclophotocoagulation (CPC) combined with anti-VEGF therapy within three days of presentation.

Findings:

• Five out of eight patients achieved controlled IOP (5-11 mmHg) without requiring subsequent aqueous shunt surgery, with a mean follow-up of 15 months.
• The remaining three patients underwent successful aqueous shunt implantation after regression of neovascularization, maintaining controlled IOP (8-14 mmHg) with no medications.
• No cases of uncontrolled inflammation, sympathetic ophthalmia, or phthisis were observed, indicating a favorable safety profile.

Implications:

• This strategy of prompt CPC with anti-VEGF offers an effective initial approach to manage IOP in acute NVG with significant angle closure.
• Aqueous shunt surgery can be effectively utilized as a secondary procedure in a controlled manner for refractory cases after neovascularization has regressed.