Neovascularization of the Iris/Angle in Primary Angle Closure Glaucoma: A Distinct Entity!

To describe cases of primary angle closure glaucoma (PACG) with neovascularization of iris/angle (NVI/NVA) with no obvious retinal pathology.

We provide a description of three patients with a diagnosis of PACG with NVI/NVA. Detailed history taking along with ophthalmic and systemic examination including slit lamp examination, gonioscopy, and fundus fluorescein angiography (FFA) was done in all patients. FFA revealed peripheral hyperfluorescence and capillary nonperfusion (CNP) areas in periphery in all three eyes. Carotid Doppler and tests for blood coagulation profile were done and no apparent cause of NVI/NVA could be found. Secondary causes of NVI such as proliferative diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome (OIS), vasculitis, branch retinal vein occlusion, central retinal artery occlusion, branch retinal artery occlusion, and ocular tumors were ruled out. All these patients had features of angle closure and were hence diagnosed with PACG with NVI/NVA. We hypothesize that chronically raised intraocular pressure (IOP) can result in peripheral retinal ischemia, leading to elevated vascular endothelial growth factor (VEGF) production resulting in NVI/NVA.

PACG with NVI/NVA in absence of an obvious retinal pathology is a separate clinical entity. NVI without any obvious retinal pathology may occur in cases of PACG on account of development of peripheral retinal nonperfusion.

PACG with NVI/NVA as per our series seem to have better prognosis than other causes of neovascular glaucoma (NVG). This distinction would help in management and follow-up. Caution should be taken to rule out all other causes.

Angmo D, Wajiri GB, Verma S, et al. Neovascularization of the Iris/Angle in Primary Angle Closure Glaucoma: A Distinct Entity!. J Curr Glaucoma Pract 2025;19(4):229-233.