This book offers a comprehensive overview of neovascular glaucoma (NVG), which is an extraordinarily aggressive type of secondary glaucoma that has often been discussed as an afterthought rather than the focal subject in glaucoma reference books. NVG is considered an end stage complication in patients with certain underlying retinal diseases, most commonly diabetic retinopathy and retinal vein occlusions. Historically, NVG has been one of the most difficult types of glaucoma to manage, with a high failure rate for traditional glaucoma surgery, and often progression of the underlying retinal disease despite “standard of care” treatment.
Chapters cover advancements made in recent years in the management of the underlying ischemic retinal conditions that lead to NVG, including the use of anti-vascular endothelial growth factor (anti-VEGF) medications. Additionally, chapters discuss glaucoma surgeries, which have become less invasive in recent years with the advent of microinvasive glaucoma surgery (MIGS). This book offers an up-to-date reference regarding current concepts in the diagnosis, as well as medical, laser, and surgical treatment of NVG in the anti-VEGF era, with attention to the close collaboration between glaucoma specialists and retina specialists.Neovascular Glaucoma - Current Concepts in Diagnosis and Treatment will change the way ophthalmologists manage NVG, ensuring patients better outcomes. It is a must-have resource for ophthalmologists worldwide.
Author(s): Mary Qiu (editor)
Series: Essentials in Ophthalmology
Publisher: Springer
Year: 2022
Language: English
Pages: 189
City: Cham
Contents
Neovascular Glaucoma: An Overview
References
Epidemiology of Neovascular Glaucoma
1 Introduction
2 Prevalence
3 Risk Factors
3.1 Age
3.2 Race
3.3 Gender
3.4 Socioeconomic Status
4 Prevalence Based on Etiology
4.1 Diabetes Mellitus
4.2 Retinal Vein Occlusions
4.3 Ocular Ischemic Syndrome
5 Conclusion
References
Pathophysiology of Neovascular Glaucoma
1 Clinical Aspects of Anterior Segment Neovascularization
2 Cell Biology of Anterior Segment Neovascularization
3 Posterior Segment Ischemia
4 Vasoproliferative Factors
4.1 Vascular Endothelial Growth Factor
4.2 Platelet-Derived Growth Factor (PDGF)
4.3 Other Angiogenic Factors
5 From Retina to Aqueous
6 Beyond Retinal Ischemia
7 Conclusions
References
Clinical Diagnosis of Neovascular Glaucoma in the Ophthalmology Office
1 Introduction
2 Clinical History
3 Examination
3.1 Visual Acuity
3.2 Pupil Examination
3.3 Intraocular Pressure (IOP)
3.4 Conjunctiva/Sclera and Cornea
3.5 Anterior Chamber
3.6 Iris
3.7 Gonioscopy
3.8 Lens
3.9 Dilated Fundus Examination
4 Ancillary Testing
4.1 Anterior Segment Photography
4.2 Visual Field Testing
4.3 Optical Coherence Tomography (OCT)
4.4 Fluorescein Angiography
4.5 B-Scan Ultrasound
4.6 Systemic Workup
5 Treatment
6 Conclusion
References
Clinical Diagnosis of Neovascular Glaucoma in the Emergency Room
1 Disease Pathogenesis
2 Clinical Presentation
3 Patient History
4 Physical Examination
5 Additional Testing
6 Treatment and Follow-Up
7 Conclusions
References
Neovascular Glaucoma in Proliferative Diabetic Retinopathy
1 Introduction
2 Epidemiology
2.1 Neovascular Glaucoma
2.2 Proliferative Diabetic Retinopathy
3 Mechanism
4 Diagnosis
4.1 History
4.2 Exam
4.3 Diagnostic Testing for Neovascularization of the Iris and Angle
5 Management
5.1 Treating the Underlying Proliferative Diabetic Retinopathy
5.2 Controlling Intraocular Pressure
5.2.1 Medical Management
5.2.2 Laser and Surgical Management
6 Conclusions and Future Directions
References
Neovascular Glaucoma in Retinal Vein Occlusions
1 Introduction
2 Pathogenesis of Neovascularization
2.1 Risk Factors for Neovascularization
3 Diagnosis
3.1 Clinical Features
3.2 Diagnostic Testing
4 Management and Treatment
4.1 Anti-VEGF Medications
4.2 Glucocorticoids
4.3 IOP-Lowering Medications
4.4 IOP-Lowering Surgery
5 Conclusion
References
Neovascular Glaucoma in Ocular Ischemic Syndrome
1 Background
2 Clinical Presentation
3 Systemic Associations and Management
3.1 Revascularization of the Carotid Artery
3.2 Ophthalmic Medical and Surgical Therapy
4 Conclusion
References
Neovascular Glaucoma in Ocular Inflammatory Disease
1 Background
2 Neovascularization Secondary to Retinal Ischemia
3 Neovascularization in the Absence of Retinal Ischemia
4 NVG in Specific Ocular Inflammatory Diseases
5 Managing NVG in Ocular Inflammatory Diseases
6 Conclusions
References
Neovascular Glaucoma in Chronic Retinal Detachments
1 Introduction
2 Biochemical Changes
3 Peripheral Vascular Changes
4 Macular Vascular Changes
5 Epidemiology
6 Surgical Management
7 Medical Management
8 Conclusion
References
Neovascular Glaucoma in Ocular Tumors and Radiation
1 Introduction
2 Neovascular Glaucoma Due to Intraocular Tumors
2.1 General Clinical Features and Diagnosis
2.2 Retinoblastoma
2.3 Medulloepithelioma
2.4 Uveal Malignant Melanoma
2.5 Uveal Metastasis
2.6 Benign Intraocular Tumors
3 Neovascular Glaucoma Due to Radiation Retinopathy
4 Conclusion
References
Treatment Goals in Neovascular Glaucoma
1 Introduction
2 Disease Staging
3 Goals of Acute Management of NVG
4 Assessing Visual Potential
5 Surgical Therapies: Using Visual Potential as a Guide
5.1 Eyes with Good Visual Potential
5.2 Eyes with Poor Visual Potential
6 Goals of Chronic Management of NVG
6.1 Baseline and Longitudinal Evaluation
6.2 Determination of a Target IOP
7 Conclusion
References
Panretinal Photocoagulation for Neovascular Glaucoma
1 Introduction
2 Mechanism of Action
3 Clinical Indications and Procedure
3.1 Proliferative Diabetic Retinopathy
3.2 Central Retinal Vein Occlusion
3.3 Retinal Artery Occlusion
3.4 Ocular Ischemic Syndrome
3.5 Combination Treatment with Anti-VEGF Agents and PRP
3.6 Limitations and Complications
4 Conclusion
References
Anti-Vascular Endothelial Growth Factor (VEGF) for Neovascular Glaucoma
1 Introduction and Anti-VEGF Mechanism of Action
2 Role of Anti-VEGF in Various Stages of NVG
2.1 Anti-VEGF Therapy in Prerubeosis Stage of NVG
2.2 Anti-VEGF Therapy in Pre-Glaucoma Stage of NVG
2.3 Anti-VEGF Therapy in Open-Angle Stage of NVG
2.4 Anti-VEGF Therapy in Closed-Angle Stage of NVG
3 Anti-VEGF Route of Administration
3.1 Intravitreal Anti-VEGF Monotherapy
3.2 Intracameral Anti-VEGF Monotherapy
3.3 Subconjunctival Anti-VEGF Monotherapy
3.4 Topical Anti-VEGF Monotherapy
4 Indications for Repeat Anti-VEGF Administration
5 Anti-VEGF as an Adjunct to Other Treatments
5.1 Anti-VEGF as an Adjunct to Panretinal Photocoagulation
5.2 Anti-VEGF as an Adjunct to Trabeculectomy
5.3 Anti-VEGF as an Adjunct to Aqueous Shunt Surgery
5.4 Anti-VEGF as an Adjunct to Microinvasive Glaucoma Surgery (MIGS)
6 Conclusion
References
Medical IOP-Lowering Therapy for Neovascular Glaucoma
1 Introduction
2 Topical Administration of IOP-Lowering Agents
3 Topical Administration of Other Agents (for Comfort)
4 Oral Administration of IOP-Lowering Agents
5 Conclusion
References
Trabeculectomy for Neovascular Glaucoma
1 Introduction
2 History
3 Bleb Morphology
4 Wound Healing after Trabeculectomy
5 Surgical Techniques
5.1 Standard Trabeculectomy
5.2 Trabeculectomy with Mitomycin C
5.3 Trabeculectomy with 5-Flurouracil
5.4 Comparison of Trabeculectomy with Mitomycin C Versus 5-Fluorouracil
5.5 Trabeculectomy with Antivascular Endothelial Growth Factor (VEGF)
5.6 Trabeculectomy with Subconjunctival Anti-VEGF
5.7 Trabeculectomy with Intracameral Anti-VEGF
5.8 Trabeculectomy with Intravitreal Anti-VEGF
5.9 Trabeculectomy with Ex-PRESS Shunt
6 Complications of Trabeculectomy in NVG
7 Risk Factors for Trabeculectomy Failure in NVG
8 Trabeculectomy Versus Aqueous Shunt
9 Conclusion
References
Aqueous Shunt for Neovascular Glaucoma Implant
1 Introduction
2 Valved and Nonvalved Aqueous Shunts in Neovascular Glaucoma
3 Nonvalved Aqueous Shunts
3.1 Molteno
3.1.1 Molteno Device and Procedure
3.1.2 Molteno Outcomes
3.2 Schocket Implant
3.2.1 Schocket Device and Procedure
3.2.2 Schocket Outcomes
3.3 Baerveldt Glaucoma Implant
3.3.1 Baerveldt Device and Procedure
3.3.2 Baerveldt Outcomes
3.4 Ahmed ClearPath
3.4.1 ClearPath Device and Procedure
3.4.2 ClearPath Outcomes
4 Valved Aqueous Shunts
4.1 Krupin Eye Valve
4.1.1 Krupin Device and Procedure
4.1.2 Krupin Outcomes
4.2 Ahmed Glaucoma Valve
4.2.1 AGV Device and Procedure
4.2.2 Ahmed Valve Outcomes
5 Complications of Aqueous Shunts for Neovascular Glaucoma
6 Suppressing the Underlying Neovascular Drive
7 Placement of Aqueous Shunts in the Ciliary Sulcus
8 Combined Aqueous Shunt and Retinal Surgery
9 Secondary Treatment Options if Aqueous Shunt Failure Occurs
10 Conclusion
References
Cyclophotocoagulation for Neovascular Glaucoma
1 Historical Perspective
2 Current Perspective
3 Case Study
4 Surgical Technique and Postoperative Management
5 Complications of CPC in Neovascular Glaucoma
6 Conclusion
References
Micro-incisional Glaucoma Surgery for Neovascular Glaucoma
1 Introduction
2 MIGS for NVG
3 Selecting the Right Patient
4 Patient Case
5 Further Considerations
6 Conclusion
References
Advancing Care in Neovascular Glaucoma
1 Introduction
2 Standardizing the Definition and Staging of NVG
3 Earlier Detection of Anterior Segment Neovascularization
4 Additional Evidence-Based Research Needed
4.1 The Role of Anti-VEGF vs. PRP Before NVG Has Developed
4.2 The Role of Anti-VEGF vs. PRP After NVG Has Developed
4.3 The Choice of IOP-Lowering Procedure After NVG Has Developed
4.4 Improving the Multidisciplinary Treatment Approach
5 Patient Adherence to Treatment
6 Conclusion
References
Index
