Neovascular glaucoma: causes, symptoms, diagnosis, treatment

Neovascular glaucoma is a secondary, closed-angle form of glaucoma. At first, the fibrovascular membrane grows on top of the trabecular network. The angle is open, but blocked. Within a short period of time, the fibrovascular membrane contracts and closes the angle of the anterior chamber, leading to a very high intraocular pressure rise, usually above 40 mm Hg.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Epidemiology of neovascular glaucoma

The exact incidence rates for all types of neovascular glaucoma are unknown. Neovascular glaucoma develops due to various pathologies, most often after ischemic thrombosis of the central vein of the retina and with proliferative diabetic retinopathy. Other predisposing factors include ischemic occlusions of the central artery of the retina, ocular ischemic syndrome, thrombosis of arteries and veins of the retina, chronic uveitis, chronic retinal detachment and radiation therapy. In studies of occlusion of the central retinal vessels (OTSS) contains some of the best reports on the incidence of neovascular glaucoma. Approximately 1/3 of all OCTS have ischemic etiology. In ischemic OTSsS, depending on the prevalence of the absence of capillary perfusion, from 16 to 60% of cases of neovascularization of the iris develop. Approximately 20% of cases of proliferative diabetic retinopathy develops neovascular glaucoma. In 18% of cases with occlusion of the central artery of the retina neovascularization of the iris develops. All eyes with neovascularization of the iris are located in a group at high risk of developing neovascular glaucoma.

[10], [11], [12], [13], [14], [15], [16], [17], [18], [19]

Symptoms of neovascular glaucoma

Disease in patients can be asymptomatic or with complaints of pain, redness of the eye and decreased vision.

Diagnosis of neovascular glaucoma

Slit Lamp

Due to increased intraocular pressure in the anterior chamber, edema of the cornea develops. The anterior chamber is usually deep, with a slight opalescence of its moisture. Hyphemus is rare, sometimes leukocytes are present. On the iris there are thin and not radial vessels.

Gonioscopy

At the initial stages of the disease with a transparent cornea during gonioscopy, a vascular network is seen in the area of the anterior chamber angle. In the future, one can see wide front peripheral synechia, covering some or all of the angle.

Rear Pole

Changes in the posterior pole correspond to the underlying disease.

[20], [21], [22], [23], [24]

Treatment of neovascular glaucoma

Drug treatment, as a rule, does not control intraocular pressure. Surgery is usually necessary. The following operations are performed: trabeculectomy using an antimetabolic drug, implantation of drains and cyclodestructive procedures.