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Anti-Vascular Endothelial Growth Factor for Neovascular Glaucoma

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Neovascular Glaucoma

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

Neovascular glaucoma (NVG) is an aggressive form of secondary glaucoma that occurs in eyes with underlying ischemic retinal vascular disease. Vascular endothelial growth factor (VEGF) plays a critical role in mediating the anterior segment neovascularization that causes aqueous outflow obstruction and elevated intraocular pressure (IOP). Anti-VEGF agents have been used as stand-alone or adjunctive treatments for NVG. Anti-VEGF agents administered via intravitreal or intracameral route are effective in rapidly regressing anterior segment neovascularization and reducing IOP in the earlier stages of the disease when the iridocorneal angle is still open. However, anti-VEGF’s effectiveness in adequately lowering IOP or reducing the need for IOP-lowering surgery in eyes that have already progressed to extensive synechial angle closure appears limited. When used as an adjunct to aqueous shunt or trabeculectomy, anti-VEGF agents have been shown to decrease intraoperative and postoperative bleeding. Compared to panretinal photocoagulation (PRP) alone, anti-VEGF combined with PRP is associated with more rapid regression of iris neovascularization and preservation of open angles. The effect of anti-VEGF on regressing anterior segment neovascularization is transient, often requiring subsequent serial anti-VEGF injections or additional PRP to definitively control the underlying neovascular drive. Despite adequate treatment of the anterior and posterior segment neovascularization, the IOP may still remain uncontrollably elevated due to fibrovascular membrane in the angle, or synechial angle closure, necessitating IOP-lowering surgery. Anti-VEGF therapy has an important role in the management of NVG, especially in the acute stages, due to its rapid effect in regressing anterior segment neovascularization, reducing intraoperative or postoperative complications, and providing some IOP reduction until definitive therapy can be instituted.

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  1. Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA

    Narine Viruni & Cindy X. Cai

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  1. Narine Viruni
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  2. Cindy X. Cai
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Correspondence to Cindy X. Cai .

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  1. Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA

    Mary Qiu

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Viruni, N., Cai, C.X. (2022). Anti-Vascular Endothelial Growth Factor for Neovascular Glaucoma. In: Qiu, M. (eds) Neovascular Glaucoma. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-11720-6_14

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  • DOI: https://doi.org/10.1007/978-3-031-11720-6_14

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