Clinical Challenges with Neovascular Glaucoma-Patient Tailored Strategies and Outcomes.

Background: To report the outcomes of patient-tailored concurrent combined surgery for retinal ischemia and intraocular pressure (IOP) control in neovascular glaucoma (NVG) with or without cataract.

Methodology: Patients with Ninety-seven (97) eyes with NVG seen between January 2022-September 2023 at a tertiary eye care centre were recruited for this study. Six (6) eyes (4 proliferative diabetic retinopathy and 2 retinal vein occlusions) that underwent concurrent retinal and glaucoma procedures with or without cataract surgery, were selected. Outcomes after surgery were judged based on the World Glaucoma Association guidelines on reporting glaucoma surgical trials, comprising functional and surgical parameters.

Results: The IOP reduced by>50% from baseline in all 6 eyes, with one eye developing shallow AC by overstraining and 3 eyes developing transient self-resolving hyphema. Two eyes received additional bevacizumab (n=1) or ranibizumab (n=1) injections for persistent DME at 4 and 5 months after surgery. The final IOP was reduced in all eyes at the final follow-up of 6±1.2 months, with one eye requiring 2 medications for IOP control.

Conclusion: The outcomes after concurrent retinal and glaucoma filtering surgery in NVG may be comparable to those of the traditional stepwise approach to management, provided these are offered on a case-by-case basis.