Abstract

Purpose: This study aimed to present the outcomes of the therapeutic interventions for neovascular glaucoma (NVG) between 2002 and 2012 at a tertiary eye hospital in Saudi Arabia.Methods: A retrospective chart review of the patients with NVG treated in the last 10 years at King Khaled Eye Specialist Hospital was carried out. The demographics, visual acuity, and intraocular pressure (IOP) at the baseline were compared to that, at last, follow-up. The clinical course of treated eyes and causes for poor vision were reviewed.Results: Among 597 eyes with NVG, the mean IOP at presentation was 32 mmHg. A total of 335 eyes (56.1%) were treated with pan-retinal photocoagulation (PRP). In 459 (77%) eyes, IOP was controlled with medications or different surgeries. The vision on the last follow-up was 20/20 to 20/40 in 19 (3%) eyes, 20/50 to 20/200 in 67 (11%) eyes, <20/200 to 20/400 in 267 (45%) eyes, and <20/400 in 225 (38%) eyes. Nineteen eyes were soft/enucleated. In 45 (8%, 95% CI 6-10) eyes vision improved. The IOP was reduced to <22 mmHg in 369 (62%, 95% CI 58.2-65.9) eyes, 23-30 mmHg in 69 (12%) eyes and was > 31 mmHg in 102 (17%) eyes. In 26 (3.7%) eyes, ocular hypotony was noted. The causes of poor vision included retinal ischemia (n=75, 13%), optic nerve head cupping (n=104, 17%), retinal detachment (n= 42, 7%) and other (n=17, 3%).Conclusion: The NVG is a serious ocular ischemic complication. Prompt therapy maintained or improved the vision and controlled IOP in 50% and more cases.

Highlights

  • Neovascular glaucoma (NVG) is a serious ocular condition that often results in devastating vision loss

  • This study presents the outcomes of therapeutic interventions for NVG at a tertiary referral eye hospital in Saudi Arabia over a 10-year period

  • A retrospective chart review was performed evaluating the eyes of patients with a diagnosis of NVG at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia

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Summary

Introduction

Neovascular glaucoma (NVG) is a serious ocular condition that often results in devastating vision loss. The key factor in treatment is the control of high intraocular pressure (IOP), which is a leading cause of permanent and substantial visual loss [1]. The pathogenesis of NVG has been linked to a locally produced angiogenic vascular endothelial growth factor (VEGF) leading to the neovascularization of the iris (NVI) and the angle (NVA) with impaired aqueous outflow [2,3]. Anterior segment neovascularization has been treated promptly with panretinal laser photocoagulation or cryotherapy [4,5,6]. Intraocular glaucoma surgery is warranted in advanced stages or cases non-responsive to medical and laser therapy [10,11].

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