Evolution of practice and management of neovascular glaucoma: a landmark review

Abstract

AbstractPurposeA comprehensive systematic review (SR) was completed evaluating patient outcomes following medical and surgical interventions targeted at controlling iris neovascularization (NVI) and neovascular glaucoma (NVG).MethodsData sources used were MEDLINE, EMBASE and Web of Science. Studies included both surgical and medical treatments in patients with NVI and NVG. Outcomes measured were intraocular pressure (IOP) lowering, failure rates, loss of visual acuity and disease regression. The SR was registered with PROSPERO.ResultsThe majority of studies retrieved during this time period were population based. A total of 159 studies were included with 148 studies being population based. 59.5% of studies were retrospective in nature and 40.5% were prospective. There were 7 randomised controlled trials and 4 non‐randomised controlled trials. The mean number of patients and eyes studied were 39 ± 42 (range 3–386) and 40 ± 47 (3–428) respectively. The mean follow‐up for all studies was 18.2 ± 24.1 (range 0.25–216) months. Significant differences were observed between glaucoma drainage devices (GDDs), diode laser and trabeculectomy in IOP lowering efficacy and failure rates; particularly with the advent of Anti‐VEGFs.ConclusionsThe unpredictable, uncommon nature of NVG is a significant limitation to high‐quality evidence on the subject. Our findings are primarily based on real‐life, non‐RCT data. We present a necessary update on the medical and surgical treatment of neovascular glaucoma particularly with increased incidence in the era of COVID‐19.