Medical and surgical management of neovascular glaucoma.

Abstract

Purpose of review: Neovascular glaucoma (NVG) is a severe secondary glaucoma precipitated by ocular ischemia and abnormal neovascularization, resulting in elevated intraocular pressure (IOP) and vision loss if not promptly addressed. This study evaluates recent advances in both medical and surgical management of NVG, focusing on strategies that integrate anti-vascular endothelial growth factor (VEGF) therapy, retinal ablation, and evolving surgical techniques.

Recent findings: Anti-VEGF agents remain central to NVG treatment, with newer agents and combination regimens showing sustained neovascular suppression, alongside panretinal photocoagulation as an additional cornerstone in reducing neovascular drive. Glaucoma drainage devices continue to have prominence for their ability to bypass fibrotic outflow pathways, while trabeculectomy augmented with mitomycin C continues to offer a viable option in select cases. Cyclodestructive procedures, including micropulse transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation, provide alternative surgical avenues for refractory cases. Novel studies including lipidomic analyses present novel metabolic pathways that are potentially implicated in NVG pathogenesis, suggesting future targets beyond VEGF.

Summary: Timely recognition and comprehensive treatment - encompassing IOP control, ischemic drive reduction, and inflammation management - remain critical in the management of NVG. As research illuminates additional molecular targets and refines surgical interventions, the promise of a more personalized, biomarker-driven approach to NVG management continues to grow.