Anti-VEGF treatment is the key strategy for neovascular glaucoma management in the short term

Abstract

BackgroundTo present a comprehensive approach for the management of patients with neovascular glaucoma (NVG) aiming to preserve visual function and complement pan-retinal photocoagulation (PRP) by anti-vascular endothelial growth factor (anti-VEGF) treatment and anti-glaucoma surgery.MethodsThis study includes a prospective, interventional case series. A process flow chart for NVG management was designed. Totally 50 patients (51 eyes) with NVG were included. Of these, 43 patients (44 eyes) completed the treatment process. Patients were divided into central retinal vein occlusion (CRVO) and proliferative diabetic retinopathy (PDR) groups according to their original diagnosis. Intraocular pressure (IOP), visual function, and the status of iris and angle neovascularization were recorded before and after treatment.ResultsPatients were followed up for 6–30 months (mean 12.2 months). The IOP of all 44 patients was effectively controlled and was significantly less after treatment (16.68 ± 4.69 mmHg) than before treatment (42.59 ± 9.44 mmHg, P < 0.05). Thirty-nine eyes displayed controlled IOP (≤21 mmHg) after treatment. Visual acuity improved, to some extent, in 32 eyes (72.9 %), and 12 eyes (27.3 %) had a visual acuity better than 0.1. There was no significant difference in IOP between the PDR and CRVO groups at the end of follow-up (P = 0.8657), but the visual acuity in the PDR group was much better than that in the CRVO group (P = 0.0079).ConclusionsA comprehensive therapy for NVG can effectively control IOP and preserve visual function in patients by anti-VEGF injection and anti-glaucoma surgery.

Prevalence, Causes and Management of Neovascular Glaucoma: A 5-Year Review

“…NVG is a refractory condition that rarely responds to medical management alone. A combination of several modalities of treatment has been shown to be more effective in intraocular pressure control, although with guarded prognosis than medical management alone [9] [10]. In this study, the most common form of treatment used was a combination of medical therapy with intraocular pressure lowering drugs and anti-vascular endothelial growth factors 13 (40.6%) ( Figure 2).…”

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

“…The primary goal of NVG treatment is to reduce IOP and posterior segment ischemia immediately, as well as to treat the underlying cause in order to prevent permanent blindness. 7,13,17 Treatment for NVG is still far from satisfactory, mostly due to the primary underlying disease, uncontrolled diabetes, which induces an uncertain hypoxia-ischemia profile. The IOP can be lowered through a combination of procedures, for example, administering antiglaucomatous medications together with PRP laser treatment as a first line of management, followed by glaucoma surgery (trabeculectomy, glaucoma drainage implant surgery, and glaucoma microstent) with or without intravitreal anti-VEGF injection when the IOP is above normal or paracentesis for rapid lowering IOP as a first intervention, followed by PRP laser treatment as a mainstay therapy to control neovascularization.…”

“…The IOP can be lowered through a combination of procedures, for example, administering antiglaucomatous medications together with PRP laser treatment as a first line of management, followed by glaucoma surgery (trabeculectomy, glaucoma drainage implant surgery, and glaucoma microstent) with or without intravitreal anti-VEGF injection when the IOP is above normal or paracentesis for rapid lowering IOP as a first intervention, followed by PRP laser treatment as a mainstay therapy to control neovascularization. [13][14][15]17,18 Laser treatment is the most common basic treatment for NVG, the aim of which is to reduce hypoxia in the surrounding retina and to recover the homeostatic balance between pro-angiogenic (i.e., VEGF) and anti-angiogenic factors. Moreover, PRP laser treatment effectively improves the state of retinal blood circulation and inhibits further release of VEGF.…”

“…Despite the great benefits of PRP laser intervention in managing NVG, this form of treatment cannot be applied in all cases, particularly in those with corneal and vitreous haziness or cataracts. 7,8,15,17 Furthermore, most traditional surgical interventions for glaucoma do not effectively reduce IOP due to the large number of neovessels on the iris surface and the angle. Damage to these vessels can lead to intraoperative bleeding.…”

Challenging Management of Neovascular Glaucoma to Achieve the Best Visual Outcome

“…In this case, intraocular anti-VEGF injection as an adjuvant should be administered. In many cases, intravitreal anti-VEGF injection preceded surgical intervention to regress neovascularization [4].…”