Author: Marianthi Bourlaki (United Kingdom)
Co-authors: Marianthi Bourlaki, Matthew Krilis, Gurjeet Jutley
NVG is a complex, secondary type of glaucoma characterised by neovascularization of the anterior part of the eye which is most commonly driven by ocular ischaemia originating at the posterior segment. There have been numerous attempts in the literature to fully explain its pathophysiology and establish therapeutic methods, conservative or surgical, with variable outcomes, which will be described in this presentation. We propose, through novel observations in the literature, that IOP may play a more significant role in the pathophysiology and overall management of NVG and may be associated with the regression of neovascularization. Furthermore, we also look at emerging treatment options and their role in the paradigm of neovascular glaucoma and suggest future directions and emerging new treatments in the management of NVG.
Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU
Literature review and current experience from our Center.
According to some recent observations, lowering IOP in NVG might play a bigger role than just a contributory effect in improving and increasing the ocular blood flow to the posterior segment of the eye. It has been argued that decreasing the IOP can cause regression of NV which eventually slows the progress to angle closure by their membranes and subsequent tractions. We have also noted similar findings in our Center of apparent regression of neovessels following acute reduction of IOP after glaucoma drainage surgery, prior to treatment to shut down the ischaemic drive in emergency settings.
It is highly relevant for the retina specialist to be up to date with the new data on neovascular glaucoma prevention and management options. Even though the decision to use anti-VEGF continues to lie with the specialist, and PRP remains the gold standard treatment, we can suggest that glaucoma surgery may be introduced earlier in the course of NVG management, in order to aggressively control IOP, in select cases.