Two-year outcomes of patients presenting to Sydney Eye Hospital with neovascular glaucoma

Abstract

Background Neovascular glaucoma (NVG) is a sight-threatening condition that is often refractory to treatment. Current management principles are yet to be standardized due to lack of evidence. We studied the interventions used to treat NVG at Sydney Eye Hospital (SEH) and the two-year surgical outcomes. Methods We performed a retrospective audit of 67 eyes of 58 patients with NVG from January 1, 2013, to December 31, 2018. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of medications, repeat surgery, recurrent neovascularization, loss of light perception and pain were studied. Results The average age of the cohort was 59.67 years (SD 14.22). The most common etiologies were proliferative diabetic retinopathy (35 eyes; 52.2%), central retinal vein occlusion (18 eyes; 26.9%) and ocular ischemic syndrome (7 eyes; 10.4%). 70.1% of eyes (47) received vascular endothelial growth factor injections (VEGFI), 41.8% (28 eyes) received pan-retinal photocoagulation (PRP) and 37.3% (25 eyes) received both prior to or within the first week of presentation to SEH. The most common initial surgical interventions were trans-scleral cyclophotocoagulation (TSCPC) (36 eyes; 53.7%) and Baerveldt tube insertion (18 eyes; 26.9%). 62.7% of eyes (42 eyes) failed (IOP > 21 or < 6 mmHg for two consecutive reviews, further IOP-lowering surgery or loss of light perception) during follow-up. Initial TSCPC failed in 75.0% (27/36 eyes) compared with 44.4% (8/18 eyes) after Baerveldt tube insertion. Conclusion Our study reinforces the refractory nature of NVG, often despite intensive treatment and surgery. Improvements in patient outcomes may be achieved with earlier consideration of VEGFI and PRP. This study identifies the limitations of surgical interventions for NVG and highlights the need for a standardized management approach.

The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study

“…The retrospective nature of our study did not allow for further differentiation between causes in this patient cohort with already severely compromised visual functions. Neovascular glaucoma and silicone oil induced glaucoma already pose a higher risk of vison loss [31,32].…”

The Association between Vascular Abnormalities and Glaucoma—What Comes First?

“…Multiple studies have reported a notable association between glaucoma, specifically open-angle glaucoma, and an increased incidence of retinal vascular occlusions [141,142]. In a comprehensive Korean nationwide population-based retrospective study, it was observed that individuals diagnosed with open-angle glaucoma exhibited a significantly elevated incidence of retinal vascular occlusions when compared to the general population [20].…”