sourcing the best research evidence in ophthalmology

Neovascular glaucoma

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Last updated: February 8th, 2022

Summary of Evidence
Evidence
References
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Summary of Evidence

Principles of management

Level A recommendations include treatment of the underlying disease origin, complete panretinal photocoagulation (if retinal ischemia is a factor), and medical control of both elevated intraocular pressure and inflammation. Level B recommendations (moderately important to patient outcome) encompass glaucoma surgery to control intraocular pressure when medical therapy is unsuccessful, although the ideal surgical procedure is unknown. {Sivak-Callcott JA, O’Day DM, Gass JD, Tsai JC. Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology. 2001 Oct;108(10):1767-76; quiz1777, 1800.}

Treatment of retinal ischemia

Anti-VEGF injections

Currently available evidence is uncertain regarding the long-term effectiveness of anti-VEGF medications as adjunct to conventional treatment in lowering IOP {Simha A, Aziz K, Braganza A, Abraham L, Samuel P, Lindsley KB. Anti-vascular endothelial growth factor for neovascular glaucoma. Cochrane Database Syst Rev. 2020 Feb 6;2(2):CD007920.}

Management of IOP

Glaucoma drainage device

Retrospective comparative study of 76 eyes of 76 patients showed that neovascular glaucoma patients have greater risk of surgical failure after Ahmed Glaucoma Valve surgery compared with controls (surgical success 20.6% vs 81.8% at 5 years). {Netland PA, Ishida K, Boyle JW. The Ahmed Glaucoma Valve in patients with and without neovascular glaucoma. J Glaucoma. 2010 Dec;19(9):581-6.}

Evidence

1. General

Review

2009 Shazly & Latina

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2009
Review

Review

2013 SooHoo et.al.

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2013
Review

1.1 Pinciples of management

Sysetmatic review

2001 Siva-Callcott et.al.

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2001
Sysetmatic review

Siva-Callcott et.al.
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1.2 Risk factors

1.2.1 In Central retinal vein occlusion

Case series

2019 Rong et.al.

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2019
Case series

Risk factors for the development of NVG in patients with acute CRVO included history of systemic hypertension, worse visual acuity on presentation, and RAPD on presentation. {Rong AJ, Swaminathan SS, Vanner EA, Parrish RK 2nd. Predictors of Neovascular Glaucoma in Central Retinal Vein Occlusion. Am J Ophthalmol. 2019 Aug;204:62-69.}

1.2.2 In uveal melanoma

Case series

2020 Kim et.al.

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2020
Case series

Of 374 eyes in patients diagnosed with uveal melanoma and treated with Iodine-125 brachytherapy, 6.7% developed neovascular glaucoma. The risk factors included: greater tumor size, greater number of pack-years smoking history, pseudophakia, and higher grade of radiation retinopathy severity by fluorescein angiogram. {Kim EA, Salazar D, McCannel CA, Kamrava M, Demanes DJ, Lamb J, Caprioli J, McCannel TA. Glaucoma After Iodine-125 Brachytherapy for Uveal Melanoma: Incidence and Risk Factors. J Glaucoma. 2020 Jan;29(1):1-10.}

1.2.3 In Proliferative diabetic retinopathy after vitrectomy

Case series

2019 Takayama et.al.

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2019
Case series

Of 268 eyes of 268patients with PDR who received vitrectomy for vitreous haemorrhage, NVG developed in 9.3% of patients and was associated with younger age, uncontrolled diabetes, no PRP, and higher frequency of postoperative vitreous haemorrhage. {Takayama K, Someya H, Yokoyama H, Takamura Y, Morioka M, Sameshima S, Ueda T, Kitano S, Tashiro M, Sugimoto M, Kondo M, Sakamoto T, Takeuchi M. Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study. Sci Rep. 2019 Oct 16;9(1):14858.}

Case series

2017 Kwon et.al.

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2017
Case series

Of 127 eyes of 127 patients with PDR who received vitrectomy for vitreous haemorrhage, NVG developed in 11.8% of patients and was associated with preoperative intravitreal bevacizumab treatment. {Kwon JW, Jee D, La TY. Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy. Medicine (Baltimore). 2017 Mar;96(10):e6263.}

2. Treat retinal ischaemia

2.1 Panretinal Photocoagulation (first-line)

2.2 Anti-VEGF injections

Review

2020 Simha et.al. (Cochrane)

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2020
Review

Simha et.al. (Cochrane)
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Systematic Review

2016 Zhou et.al.

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2016
Systematic Review

Use of intravitreal bevacizumab pretreatment prior to ahmed glaucoma valve implantation was associated with greater complete success rate compared to no bevacizumab, and lower frequency of hyphaema {Zhou M, Xu X, Zhang X, Sun X. Clinical Outcomes of Ahmed Glaucoma Valve Implantation With or Without Intravitreal Bevacizumab Pretreatment for Neovascular Glaucoma: A Systematic Review and Meta-Analysis. J Glaucoma. 2016 Jul;25(7):551-7.}

2.3 Cryotherapy

3. Treat inflammation

3.1 Steroids (topical)

3.2 Cycloplegia

4. Management of IOP

Refer to Primary Open Angle Glaucoma

4.1 Glaucoma drainage device

Case series

2019 Xie et.al.

Article link

2019
Case series

Retrospective case series of 66 eyes of 59 NVG patients who underwent Ahmed glaucoma valve implantation showed surgical success (defined as 6 mm Hg < IOP < 21 mmHg with or without additional medications) of 66.7% at 12 months. {Xie Z, Liu H, Du M, Zhu M, Tighe S, Chen X, Yuan Z, Sun H. Efficacy of Ahmed Glaucoma Valve Implantation on Neovascular Glaucoma. Int J Med Sci. 2019 Sep 20;16(10):1371-1376.}

Case series

2010 Netland et.al.

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2010
Case series

References

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