Iris cerclage with goniosynechialysis and canalicular stent for neovascular angle closure glaucoma

To report a surgical treatment for neovascular angle closure glaucoma.

A 69 year-old man with proliferative diabetic retinopathy developed neovascular angle closure with intraocular pressure (IOP) 60 mm Hg. Surgical goniosynechialysis and placement of a Hydrus canalicular stent were combined with pupilloplasty using an iris cerclage suture to maintain tension on the peripheral iris to limit reformation of goniosynechiae. Intravitreal injections to block vascular endothelial growth factor (VEGF) were given as needed and IOP ranged 10-20 mm Hg with 3 topical medications in the 21 months following his surgery.

Goniosynechialysis, Hydrus stent, and iris cerclage pupilloplasty with ongoing anti-VEGF injections may be an alternative to tube shunt implant or cyclophotocoagulation for patients with neovascular glaucoma.