SCOPING: A Multidisciplinary Treatment Protocol for Neovascular Glaucoma with Completely Open or Partially Open...

A standardized multidisciplinary treatment protocol for NVG was developed in 2020 at the University of Chicago and has been termed Salvaging the Conventional Outflow Pathway in Neovascular Glaucoma (SCOPING). We describe 9 eyes with anterior segment neovascularization and at least partially open angles that underwent the SCOPING protocol to suppress the underlying neovascular drive, control intraocular pressure, and medically or surgically salvage the angle whenever possible.

Nine eyes from 8 patients with first-time anterior segment neovascularization, at least partially open angles, and normal or elevated IOP were treated with 6 serial monthly intravitreal bevacizumab injections interspersed with pan-retinal photocoagulation.

Five eyes with completely open angles without any peripheral anterior synechiae and each achieved and/or maintained physiologic IOP without requiring surgery. The other 4 eyes presented with partially open angles. Three out of these 4 eyes required subsequent IOP-lowering surgery. None of the 9 eyes developed recurrence of anterior segment neovascularization during the treatment protocol.

This protocol may be utilized to salvage the conventional outflow pathway for patients with partially or completely open angles. The etiology and diagnosis of neovascular glaucoma have been established. Current treatment strategies include reduction of neovascular drive including panretinal photocoagulation, intravitreal injections, intraocular pressure lowering medications, and filtration surgery. However, a protocol has not been developed to treat neovascular glaucoma (NVG). Our SCOPING protocol may be helpful for glaucoma specialists in treating patients with neovascular glaucoma.