Management of Neovascular Glaucoma

Management of NVG remains a therapeutic challenge. The diagnosis of NVG should be made as early as possible if the patient is to be provided the best chance to maintain vision. To achieve this goal, a high index of suspicion, a full ocular examination including undilated gonioscopy, and pupil examination are essential. There are two key aspects to the management of NVG: treatment of the underlying disease process responsible for rubeosis and treatment of the increased IOP. Treatment of rubeosis is directed at the ischemic retina in most cases. Panretinal photocoagulation (PRP) is considered the treatment of choice. However, other modalities such as panretinal cryotherapy, transscleral diode laser retinopexy, and panretinal diathermy have been described. Medical management of NVG consists of IOP-lowering agents, including topical ßadrenergic antagonists, alpha-2 agonists, and topical and oral carbonic anhydrase inhibitors. However, once the angle is synechially closed, medical management becomes unsuccessful and one has to resort to surgical management. Although the ideal surgical procedure has yet to be determined, trabeculectomy with antimetabolite therapy, aqueous shunt implants, and diode laser cyclophotocoagulation are the best current surgical options. Studies have shown VEGF as a key molecule in ocular angiogenesis and direct targeting of VEGF might be another possible therapeutic strategy to treat neovascu-