Experience and challenges in the treatment of neovascular glaucoma_Chinese Journal of Ocular Fundus Diseases

Authors：

 Wang Zhijun , Sun Chuan

Department of Ophthalmology, China-Japan Friendship Hospital, Beijing 100029, China;

Corresponding author：

Wang Zhijun, Email: wangzj301@sina.com

Keywords：

Neovascular glaucoma/etiology; Neovascular glaucoma/treatment; Editorial

DOI：

10.3760/cma.j.cn511434-20210410-00198

Video：

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Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.

Citation： Wang Zhijun, Sun Chuan. Experience and challenges in the treatment of neovascular glaucoma. Chinese Journal of Ocular Fundus Diseases, 2021, 37(6): 415-417. doi: 10.3760/cma.j.cn511434-20210410-00198 Copy

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2.	Hayreh SS. Neovascular glaucoma[J]. Prog Retin Eye Res, 2007, 26(5): 470-485. DOI: 10.1016/j.preteyeres.2007.06.001.
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4.	Sun JT, Liang HJ, An M, et al. Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma[J]. Int J Ophthalmol, 2017, 10(3): 400-405. DOI: 10.18240/IJO.2017.03.12.
5.	Mahdy RA, Nada WM, Fawzy KM, et al. Efficacy of intravitreal bevacizumab with panretinal photocoagulation followed by ahmed valve implantation in neovascular glaucoma[J]. J Glaucoma, 2013, 22(9): 768-772. DOI: 10.1097/IJG.0b013e318259aec4.
6.	Tang M, Fu Y, Wang Y, et al. Efficacy of intravitreal ranibizumab combined with ahmed glaucoma valve implantation for the treatment of neovascular glaucoma[J/OL]. BMC Ophthalmol, 2016, 16: 7[2016-01-09]. https://pubmed.ncbi.nlm.nih.gov/26749079/. DOI: 10.1186/s12886-016-0183-7.
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8.	Shen X, Chen Y, Wang Y, et al. Intravitreal ranibizumab injection as an adjuvant in the treatment of neovascular glaucoma accompanied by vitreous hemorrhage after diabetic vitrectomy[J/OL]. J Ophthalmol, 2016, 2016: 4108490[2016-05-16]. https://pubmed.ncbi.nlm.nih.gov/27293875/. DOI: 10.1155/2016/4108490.
9.	Liu L, Xu Y, Huang Z, et al. Intravitreal ranibizumab injection combined trabeculectomy versus ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications[J/OL]. BMC Ophthalmol, 2016, 16: 65[2016-05-26]. https://pubmed.ncbi.nlm.nih.gov/27230388/. DOI: 10.1186/s12886-016-0248-7.
10.	Simha A, Aziz K, Braganza A, et al. Anti-vascular endothelial growth factor for neovascular glaucoma[J/OL]. Cochrane Database Syst Rev, 2020, 2(2): CD007920[2020-02-06]. https://pubmed.ncbi.nlm.nih.gov/32027392/. DOI: 10.1002/14651858.CD007920.pub3.
11.	Olmos LC, Sayed MS, Moraczewski AL, et al. Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab[J]. Eye (Lond), 2016, 30(3): 463-472. DOI: 10.1038/eye.2015.259.
12.	Sun C, Zhang HS, Yan YJ, et al. Early vitrectomy combined with pan retinal photocoagulation, anti-vascular endothelial growth factor, and gradual cyclophotocoagulation for treatment of neovascular glaucoma[J]. Chin Med J (Engl), 2019, 132(20): 2518-2520. DOI: 10.1097/CM9.0000000000000482.
13.	Yan H. Outcomes of 23-Gauge vitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy without use of anti-VEGF agents for neovascular glaucoma with vitreous hemorrhage[J/OL]. J Ophthalmol, 2016, 2016: 3097379[2016-01-07]. https://pubmed.ncbi.nlm.nih.gov/26885379/. DOI: 10.1155/2016/3097379.
14.	Shchomak Z, Cordeiro Sousa D, et al. Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis[J]. Graefe's Arch Clin Exp Ophthalmol, 2019, 257(6): 1079-1089. DOI: 10.1007/s00417-019-04256-8.
15.	Higashide T, Ohkubo S, Sugiyama K. Long-term outcomes and prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma[J/OL]. PLoS One, 2015, 10: e0135766[2015-08-14]. https://pubmed.ncbi.nlm.nih.gov/26275060/. DOI: 10.1371/journal.pone.0135766.
16.	Kim M, Lee C, Payne R, et al. Angiogenesis in glaucoma filtration surgery and neovascular glaucoma: a review[J]. Surv Ophthalmol, 2015, 60(6): 524-535. DOI: 10.1016/j.survophthal.2015.04.003.
17.	Sun C, Zhang H, Tang Y, et al. Aqueous inflammation and ischemia-related biomarkers in neovascular glaucoma with stable iris neovascularization[J]. Curr Eye Res, 2020, 45(12): 1504-1513. DOI: 10.1080/02713683.2020.1762226.
18.	Hong Y, Hu Y, Dou H, et al. Comparison of the safety and efficacy of triple sequential therapy and transscleral cyclophotocoagulation for neovascular glaucoma in the angle-closure stage[J/OL]. Sci Rep, 2018, 8(1): 7074[2018-05-04]. https://pubmed.ncbi.nlm.nih.gov/29728640/. DOI: 10.1038/s41598-018-25394-9.
19.	Chalam KV, Brar VS, Murthy RK. Human ciliary epithelium as a source of synthesis and secretion of vascular endothelial growth factor in neovascular glaucoma[J]. JAMA ophthalmol, 2014, 132(11): 1350-1354. DOI: 10.1001/jamaophthalmol.2014.2356.

1. Havens SJ, Gulati V. Neovascular glaucoma[J]. Dev Ophthalmol, 2016, 55: 196-204. DOI: 10.1159/000431196.
2. Hayreh SS. Neovascular glaucoma[J]. Prog Retin Eye Res, 2007, 26(5): 470-485. DOI: 10.1016/j.preteyeres.2007.06.001.
3. Sun Y, Liang Y, Zhou P, et al. Anti-VEGF treatment is the key strategy for neovascular glaucoma management in the short term[J/OL]. BMC Ophthalmol, 2016, 16(1): 150[2016-08-30]. https://pubmed.ncbi.nlm.nih.gov/27576739/. DOI: 10.1186/s12886-016-0327-9.
4. Sun JT, Liang HJ, An M, et al. Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma[J]. Int J Ophthalmol, 2017, 10(3): 400-405. DOI: 10.18240/IJO.2017.03.12.
5. Mahdy RA, Nada WM, Fawzy KM, et al. Efficacy of intravitreal bevacizumab with panretinal photocoagulation followed by ahmed valve implantation in neovascular glaucoma[J]. J Glaucoma, 2013, 22(9): 768-772. DOI: 10.1097/IJG.0b013e318259aec4.
6. Tang M, Fu Y, Wang Y, et al. Efficacy of intravitreal ranibizumab combined with ahmed glaucoma valve implantation for the treatment of neovascular glaucoma[J/OL]. BMC Ophthalmol, 2016, 16: 7[2016-01-09]. https://pubmed.ncbi.nlm.nih.gov/26749079/. DOI: 10.1186/s12886-016-0183-7.
7. Iliev ME, Domig D, Wolf-Schnurrbursch U, et al. Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma[J]. Am J Ophthalmol, 2006, 142(6): 1054-1056. DOI: 10.1016/j.ajo.2006.06.066.
8. Shen X, Chen Y, Wang Y, et al. Intravitreal ranibizumab injection as an adjuvant in the treatment of neovascular glaucoma accompanied by vitreous hemorrhage after diabetic vitrectomy[J/OL]. J Ophthalmol, 2016, 2016: 4108490[2016-05-16]. https://pubmed.ncbi.nlm.nih.gov/27293875/. DOI: 10.1155/2016/4108490.
9. Liu L, Xu Y, Huang Z, et al. Intravitreal ranibizumab injection combined trabeculectomy versus ahmed valve surgery in the treatment of neovascular glaucoma: assessment of efficacy and complications[J/OL]. BMC Ophthalmol, 2016, 16: 65[2016-05-26]. https://pubmed.ncbi.nlm.nih.gov/27230388/. DOI: 10.1186/s12886-016-0248-7.
10. Simha A, Aziz K, Braganza A, et al. Anti-vascular endothelial growth factor for neovascular glaucoma[J/OL]. Cochrane Database Syst Rev, 2020, 2(2): CD007920[2020-02-06]. https://pubmed.ncbi.nlm.nih.gov/32027392/. DOI: 10.1002/14651858.CD007920.pub3.
11. Olmos LC, Sayed MS, Moraczewski AL, et al. Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab[J]. Eye (Lond), 2016, 30(3): 463-472. DOI: 10.1038/eye.2015.259.
12. Sun C, Zhang HS, Yan YJ, et al. Early vitrectomy combined with pan retinal photocoagulation, anti-vascular endothelial growth factor, and gradual cyclophotocoagulation for treatment of neovascular glaucoma[J]. Chin Med J (Engl), 2019, 132(20): 2518-2520. DOI: 10.1097/CM9.0000000000000482.
13. Yan H. Outcomes of 23-Gauge vitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy without use of anti-VEGF agents for neovascular glaucoma with vitreous hemorrhage[J/OL]. J Ophthalmol, 2016, 2016: 3097379[2016-01-07]. https://pubmed.ncbi.nlm.nih.gov/26885379/. DOI: 10.1155/2016/3097379.
14. Shchomak Z, Cordeiro Sousa D, et al. Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis[J]. Graefe's Arch Clin Exp Ophthalmol, 2019, 257(6): 1079-1089. DOI: 10.1007/s00417-019-04256-8.
15. Higashide T, Ohkubo S, Sugiyama K. Long-term outcomes and prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma[J/OL]. PLoS One, 2015, 10: e0135766[2015-08-14]. https://pubmed.ncbi.nlm.nih.gov/26275060/. DOI: 10.1371/journal.pone.0135766.
16. Kim M, Lee C, Payne R, et al. Angiogenesis in glaucoma filtration surgery and neovascular glaucoma: a review[J]. Surv Ophthalmol, 2015, 60(6): 524-535. DOI: 10.1016/j.survophthal.2015.04.003.
17. Sun C, Zhang H, Tang Y, et al. Aqueous inflammation and ischemia-related biomarkers in neovascular glaucoma with stable iris neovascularization[J]. Curr Eye Res, 2020, 45(12): 1504-1513. DOI: 10.1080/02713683.2020.1762226.
18. Hong Y, Hu Y, Dou H, et al. Comparison of the safety and efficacy of triple sequential therapy and transscleral cyclophotocoagulation for neovascular glaucoma in the angle-closure stage[J/OL]. Sci Rep, 2018, 8(1): 7074[2018-05-04]. https://pubmed.ncbi.nlm.nih.gov/29728640/. DOI: 10.1038/s41598-018-25394-9.
19. Chalam KV, Brar VS, Murthy RK. Human ciliary epithelium as a source of synthesis and secretion of vascular endothelial growth factor in neovascular glaucoma[J]. JAMA ophthalmol, 2014, 132(11): 1350-1354. DOI: 10.1001/jamaophthalmol.2014.2356.

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