Neovascular Glaucoma: Etiology, Diagnosis and Prognosis

Shazly, Tarek A.; Latina, Mark A.

doi:10.1080/08820530902800801

Cited by 128 publications

(135 citation statements)

References 28 publications

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“…1 The prognosis of NVG is typically poor with devastating visual consequences. 2 Common causes of NVG include central retinal vein occlusion (CRVO), diabetic retinopathy, and carotid artery occlusive disease, among many other ischemic diseases. [2][3][4] These conditions share a common underlying initiating mechanism as a predisposition for developing NVG-retinal ischemia.…”

Section: Introductionmentioning

confidence: 99%

“…2 Common causes of NVG include central retinal vein occlusion (CRVO), diabetic retinopathy, and carotid artery occlusive disease, among many other ischemic diseases. [2][3][4] These conditions share a common underlying initiating mechanism as a predisposition for developing NVG-retinal ischemia. As the presenting signs and symptoms of NVG are usually a late manifestation of the causative disease processes, NVG poses a great challenge for ophthalmologists and is often devastating for patients.…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Olmos

Sayed

Moraczewski

et al. 2015

Eye

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Aims To compare the outcomes of neovascular glaucoma (NVG) treated with and without intravitreal bevacizumab in a large case comparison study. Methods The study is a retrospective, comparative, case series of 163 eyes of 151 patients with NVG, including 99 treated without and 64 treated with intravitreal bevacizumab. Medical and surgical treatments for NVG were assessed. The main outcome measures were visual acuity (VA) and intraocular pressure (IOP).Results At the time of NVG diagnosis, the median VA was count fingers (CF) in the non-bevacizumab group and 2/300 in the bevacizumab group. IOP (mean ± SD) was 43.1 ± 13.0 mm Hg in the non-bevacizumab group and 40.8 ± 11.5 mm Hg in the bevacizumab group. IOP (mean ± SD) decreased to 18.3 ± 13.8 mm Hg in the nonbevacizumab group and 15.3 ± 8.0 mm Hg in the bevacizumab group, and the median VA was CF in both treatment groups at a mean follow-up of 12 months. Panretinal photocoagulation (PRP) substantially reduced the need for glaucoma surgery (Po0.001) in bevacizumab treated NVG eyes. Conclusions Although bevacizumab delayed the need for glaucoma surgery, PRP was the most important factor that reduced the need for surgery. Vision and IOP in eyes with NVG treated with bevacizumab showed no long-term differences when compared with eyes that were not treated with bevacizumab. Thus, intravitreal bevacizumab serves as an effective temporizing treatment, but is not a replacement for close monitoring and definitive treatment of NVG. PRP remains the treatment modality that affects the course of NVG in terms of decreasing the need for surgery to control IOP.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Olmos

Sayed

Moraczewski

et al. 2015

Eye

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“…With long-term use of oral carbonic anhydrase inhibitors, close monitoring of electrolytes is important especially in those with concomitant renal disease. Initial prostaglandin use may help, but their effectiveness maybe impaired if a fibrovascular membrane obstructs the uveal outflow path [6]. Furthermore, prostaglandins may exacerbate ocular inflammation.…”

Section: Medical Therapymentioning

confidence: 99%

“…Cycloplegic agents can relieve discomfort, inflammation and decrease IOP. Despite these measures, failure of medical therapy alone is the norm especially in advanced NVG [6].…”

Section: Medical Therapymentioning

confidence: 99%

A paradigm shift in the management of neovascular glaucoma

Jeganathan¹,

Wardrop²

2016

New Front Ophthalmol

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Neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) is a potentially devastating condition. The commonest cause of treatment failure in NVG is underlying systemic disease progression. The underlying ischemia is often refractory to medical treatment. Surgical options have evolved to include Bevacizumab in the Ophthalmologist's armamentarium. Visual prognosis can be guarded in these patients who additionally have reduced life expectancy. Thus, early diagnosis and aggressive treatment is imperative to avert visual loss, and improve their prognosis. We present a case of NVG secondary to PDR which was challenging to treat. The patient adherent to his treatment plan and achieved unusually successful results, maintaining good vision.

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“…The various management options for treatment of neovascular glaucoma are outside the scope of this paper. They include palliative ophthalmic measures to reduce intra-ocular pressure and pain, blockage of vascular endothelial growth factor (VEGF)-A using anti-VEGF drugs [37] and, in some cases, enucleation must be the end line option [38][39][40].…”

Section: Clinical Featuresmentioning

confidence: 99%

Diabetic Retinopathy: Understanding Pathologic Angiogenesis and Exploring its Treatment Options

Falcão¹

2012

TOCVJ

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Diabetic retinopathy is the major cause of blindness at working age. The pathogenesis behind visual loss is related with retinal angiogenesis and increased retinal vascular permeability. These changes seem to be the result of chronic hyperglycemia and hypoxia. Several mechanisms have been proposed to cause the retinal and vasculature cellular damage. They include the formation of advanced end glycation products, aldose reductase activity and reactive oxygen species. Ultimately, they lead to the expression of VEGF-A. This growth factor seems to play the pivotal role in the development of the complications associated with the disease including break down of the inner blood retinal barrier, macular edema and vasoproliferation. Other mechanisms like inflammation, protein kinase C activity and erythropoietin have been strongly associated with the pathogenesis.Laser therapy is still the standard of care for diabetic retinopathy and prevents severe vision loss in 95% of patients if timely treatment is performed. The better understanding of the disease has led to the production of new management options that may become important adjuvants for the disease. They include intravitreal anti-VEGF therapy, intravitreal steroid therapy and systemic protein kinase C inhibitors. Vitrectomy is an important option for advanced cases of the disease such as tractional retinal detachment or non-absorbing vitreous hemorrhages.

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Neovascular Glaucoma: Etiology, Diagnosis and Prognosis

Cited by 128 publications

References 28 publications

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

A paradigm shift in the management of neovascular glaucoma

Diabetic Retinopathy: Understanding Pathologic Angiogenesis and Exploring its Treatment Options

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