[Neovascular glaucoma in the diabetic patient]

Neovascular glaucoma is the final complication of diabetic proliferative retinopathies. Its incidence had significantly reduced during these last ten years owing to the improvement of the management of diabetic patients and systematic panretinal photocoagulation for the treatment of these proliferative retinopathies. Contrary to the other causes of neovascular glaucomas, its evolution is usually capricious, bilateral and its delay of appearance may be quite variable. Vitrectomy--when non associated to peroperative endoretinal photocoagulation--and cataract extraction--mainly intracapsular cataract extraction--increase significantly the incidence of this complication. Fluorescein angiography of the anterior segment and fluorescein gonio-angiography may be contributive to the diagnosis of early rubeosis iridis and/or to evaluation of the efficacy of panretinal photocoagulation. Its management must remain as conservative as possible. It lies upon panretinal photocoagulation and/or cryoablation, both representing the preventive and the curative treatment of this secondary glaucoma. Secondarily a filtering procedure associated with antimetabolites or an anterior chamber drainage implant may be discussed individually if necessary and according to the residual visual function.