Therapeutic approaches in neovascular glaucoma

Abstract

Neovascular glaucoma (NVG) is a severe type of secondary glaucoma caused by a variety of disorders, like diabetic retinopathy, central or branch vein occlusion or vascular ischemic syndrome. NVG is a devastating type of glaucoma with poor prognosis. It is caused by neovascularization in the angle of the anterior chamber which impairs aqueous outflow in the presence of an open angle and later contracts to produce a secondary angle-closure. Aim of the study is to show different methods of treatment, an algoritm, and follow-up in neovascular glaucoma. Methods: We studied neovascular glaucoma caused by the following conditions: diabetic retinopathy, central vein occlusion, and ocular ischemic syndrome. The treatment was medical, laser and surgical. We performed trabeculectomy with antimetabolites Mitomicin C, 5- Florouracil,and antifibrotic agent Interferon alfa-2b. Beside this surgical procedure we associated panretinal photocoagulation and intravitreal injection with bevacizumab, aflibercept Results: We analyzed the ethiology of NVG, the role and the efficiency of the antiglaucomatous surgery and the surgical technique used. We analysed also the efficiency of anti VEGF factor used. The fragment of trabecul excised was examined histopatological. . Cyclophotocoagulation; MicroPulse transcleral laser therapy was also used in the last 2 years. In most cases we managed to preserve the remaining vision and reduce the pain. Conclusions: Neovascular glaucoma is a very difficult pathology and is very hard to manage. The treatment should begin very early. The use of panretinal photocoagulation and intravitreal injection can reduce the neovascularization of the iris and angle and normalize the intraocular pressure. Surgery with antimetabolites and antifibrotic agents is important to avoid the bleb fibrosis.