Theraupatic Strategy of neovascular glaucoma

Nvg strategies

1. Theurapatic Strategies for Neovascular glaucoma

2. Introduction Neovascular glaucoma (NVG) is a type of secondary glaucoma that potentially leads to irreversible vision loss and blindness. firstly reported by Weiss et  al.z in 1963 NVG is characterized by progressive neovascularization in the iris (NVI) and angle (NVA) NVG secondary to PDR, retinal vein occlusion and ocular ischemic syndrome , which causes retinal ischemia/hypoxia and subsequent release of angiogenesis factors are more common.  Inflamatory causes,RD and tumors can also cause NVG

3. SERIES OF CASES CASE 1: A 67 years female diagnosed as LE CRVO with NVG LE IVB 1 dose was given and PRP was done and started on AGM RE LE V/A 6/12 PL + IOP 15 49 A/S LOW BLEB, PI AT 12 O’CLOCK 360 DEGREE NVI GOINIOSCOPY OPEN NVA + ,OCCLUDABLE P/S CDR 0.8, IR LOSS CRVO, GOA RE LE V/A HM 6/18 IOP 49 18 A/S CONGESTION,CORNEAL EDEMA ,FLORID NVI IMC GONIOSCOPY NVA, OPEN OPEN P/S NO VIEW D/T CORNEAL EDEMA CDR 0.5 CASE 2: A 66 years male diagnosed as RE CRVO with NVG. RE ARC was done and 1 dose IVB given and AGM started. Later, PRP was done.

4. CASE 1 CASE 2

5. RE LE 1. V/A 5/60 5/60 2. IOP 14 mmHG 44 mmHG 3. ANTERIOR SEGMENT No NVI NVI +, Ectropion uvea + 4. GONIOSCOPY OPEN ANGLE NVA + with PAS 5. POSTERIOR SEGMENT VH, no view PDR RE LE V/A PL - 6/60 IOP 54 24 A/S CORNEAL EDEMA, FLORID NVI, NVI FROM 9 -11 O’CLOCK GONIOSCOPY NVA NVA SUPERIORLY AND OPEN ANGLE. P/S HAZY, GOA PDR WITH VH. INFERIOR LASER MARKS SEEN CASE 4: A 47 years male diagnosed as BE PDR with LE NVG. IVB 1 dose was given and PRP was done and patient started on AGM.IOP not controlled with MMT,PRP,IVB. AADI with PPV done. CASE 3: A 60 years male diagnosed as BE PDR with BE NVG, RE absolute glaucoma. ARC, IVB 1 dose was given and PRP was done. IOP not controlled with MMT,PRP,ARC. AADI with PPV done. RE LE V/A 1/2/60 6/6P IOP 14 16 A/S NVI, Normal GONIOSCOPY NVA, Open Open P/S VH CDR 0.8,Mild NPDR CASE 5: A 67 years male diagnosed as RE OIS with NVI & NVA. IVB 1 dose was given F/B PRP.K/C/O BE POAG on AGM.

6. NEOVASCULO GENESIS Pseudophakic & Victrectomized eyes at risk

7. THE TIME SEQUENCE OF PROGRESSION FROM RUBEOSIS IRIDIS - ANGLE CLOSURE IS VARIABLE CRVO – FULMINANT COURSE DIABETIC RETINOPATHY – SLOW COURSE WHY ? IN DIABETIC RETINOPATHY , PERHAPS IT TAKES A LONGER TIME FOR ENOUGH RETINA TO BECOME ISCHEMIC

8. WHAT TO LOOK FOR IN NVG?!!

9. Pre Rubeosis Combined with treatment of underlying cause ARC

10. CONCLUSION I ntensive and aggressive treatment of the primary disease to reduce retinal ischemia should be of the highest priority Close follow ups are necessary. C ombination of anti-VEGF injection, PRP in time, and prompt IOP control give a better prognosis. Early detection with patient awareness can give better outcomes.

11. Thank You