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

Abstract

Background: To 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.

Methods: This 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.

Results: Patients 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).

Conclusions: A comprehensive therapy for NVG can effectively control IOP and preserve visual function in patients by anti-VEGF injection and anti-glaucoma surgery.

Keywords: Anti-VEGF therapy; Anti-glaucoma surgery; Neovascular glaucoma; Pan-retinal photocoagulation.

Fig. 1

A chart of the neovascular glaucoma treatment process

Fig. 2

Visual acuity before and after treatment. A total of 32 (72.9 %) eyes showed improved vision, to various degrees. Of these, 12 (27.3 %) had a visual acuity ≥0.1, 9 (20.5 %) remained unchanged, and 3 (6.8 %) became worse. Of the NLP eyes at the time of diagnosis, 3 of 5 had re-acquired their visual acuity at the end of treatment and had visual acuity values of 0.05, 0.04, and 0.01

Fig. 3

Typical examination results of a 53-year-old man diagnosed with CRVO combined with NVG in the right eye. His physical examination was demonstrated in a and b. c showed the clinical finding after a trabeculectomy. At the patient’s follow-ups at 12 (e) and 24 (f) months after discharge, his visual acuity was 0.03 and his IOP was 18 mmHg in the right eye. No leakage was observed in FFA (d)

Fig. 4

Typical examination results of a 46-year-old woman diagnosed with PDR combined with NVG. a Demonstrated in the physical examination. The cornea returned to clear after a trabeculectomy (b, d). PRP was carried out (e). At the end of the follow-up, at 10 months after the patient’s discharge, her visual acuity was 0.05 and her IOP was 20 mmHg in the left eye (c). No leakage was observed in FFA leakage (f)