Neovascular glaucoma at a tertiary Centre in Finland, 2008-2024: A retrospective cohort study

Neovascular glaucoma (NVG) is a refractory secondary glaucoma, yet longitudinal outcome data remain limited. This study reports its aetiologies, treatments and outcomes.

Patients with NVG were identified through electronic medical record review. Inclusion required documented rubeosis of the iris and/or anterior chamber angle, an intraocular pressure (IOP) ≥25 mmHg, diagnosis during 2008-2024, and follow-up at Helsinki University Hospital. Baseline data and all follow-up visits were included.

Of 919 patients identified, 626 met inclusion criteria, with a median follow-up of 24 months. The estimated NVG incidence was 2.2/100000/year. The most common aetiology was central retinal vein occlusion (CRVO; 45%), followed by diabetic retinopathy (DR; 14%), central retinal artery occlusion (CRAO; 11%) and ocular ischaemic syndrome (8%). Half of the patients had hand motion vision or worse at baseline, with 18% at no light perception (NLP). At 5 years, 14% had decimal 0.1 vision or better. Visual outcomes differed by aetiology, with median time to NLP ranging from 1.6 (CRAO) to 9.1 (DR) years (log-rank p = 0.002). Median baseline IOP was 40 mmHg, decreasing to 20 mmHg by 1 year. Ocular pain fell from 43% at baseline to 11% at last follow-up. Structural eye loss (e.g. enucleation or phthisis) occurred in 3% by 5 years.

The estimated NVG incidence was lower than previously reported elsewhere. Unlike other cohorts where DR predominates, CRVO was the most common aetiology and visual prognosis was strongly aetiology-dependent. Glaucoma drainage device surgery reached 8% at 3 years, despite the severity and refractory nature of NVG.