Vous êtes sur la page 1sur 20

Neovascular Glaucoma

Gowri J Murthy
Neovascular Glaucoma
- Neovascularisation of iris and angle occurs in response to a stimulus
- Most common cause- retinal ischemia
- Proliferative Diabetic retinopathy
- Ischemic Retinal Vein occlusion
- Ocular ischemic syndrome.
- Mediated by VEGF.

Gowri J Murthy
Case 1
• Mr B.
• Age- 72y
• Presented with c/o decrease in vision OD
• Systemic History: DM- 35 years, HT 30 yrs.
• Medication : on Insulin and OHA, Telmisartan

Gowri J Murthy
Examination
• BCVA- 6/9, n6 OU
• A/s – OD
• Pupil 3mmrrr
• IOP – 18 mmhg

• OS - WINL

Gowri J Murthy
Gonio - OD

Gowri J Murthy
Fundus:
• PDR.

Gowri J Murthy
Diagnosis
• OD_ SIMC, NVI/NVA, PDR
• OS- SIMC, severe NPDR

• Early diagnosis !!

Gowri J Murthy
Management
• Pan Retinal Photocoagulation- 3 sittings
• Role of Intravitreal Antivegf
• Close monitoring of IOP
• Close monitoring of the other eye.

Gowri J Murthy
Case 2
• Mrs.PB
• Age- 65 yrs
• c/o pain, and redness and decreased vision OS
• Past history: S/P Phaco with IOL 4 months back OU
• Systemic history : DM- 15 yrs, HT- 18 yrs, IHD- 5 yrs.
• Meds : OHA, Amlodepine.

Gowri J Murthy
Examination
• BCVA:
• OD- 6/6, n6,
OS- 6/12 , n6

• A/S-
• OD- wnl
• OS-

• IOP
• OD 17 mmhg
• OS- 32 mmhg

Gowri J Murthy
Gonio-
• OD- open angles
• OS - synechiae- 2 quad, NVA

Gowri J Murthy
Fundus - OS
• PDR

Gowri J Murthy
Diagnosis
• OD- Pseudophakia, severe NPDR
• OS- pseudophakia, PDR, NVG

• Good BCVA
• Established elevated IOP
• Synechial angle closure partly.

Gowri J Murthy
Management
• Underlying Pathology
• Intraviteral AntiVEGF
• PRP- 3 sittings

• IOP
• Medical : Aqueous suppressants, G Timolol, G Brimonidine, G Dorzolamide
• Systemic Acetazolamide
• G Atropine
• G Dexamethasone

Gowri J Murthy
Further management
• Post AntiVEGF, after MMT
• IOP remains at 34-40 mmhg
• Prp 3 done

• Surgical Options
• Trab with MMC
• AGV Implant

Gowri J Murthy
Case 3
• Mr RS
• Age 69 yrs
• C/o Pain Right eye and one sided headache with loss of vision Right
eye
• Past history: laser for Diabetic retinopathy both eyes, OS AntiVEGF
injn intravitreal 1 yr back, followed by further Laser
• Systemic : DM- 25 yrs, nephropathy on dialysis, HT, IHD

Gowri J Murthy
• OD- BCVA- NPL , IOP- 52 mmhg Gowri J Murthy
• OS- BCVA- 6/24
• a/s-
• ectropion uvea, no NVI
• mid dilated pupil
• SIMC
• IOP 18 mmhg ( Timolol +
dorzolmide)
• Gonio- open, patchy PAS,
no NVA

• Fundus_
• OD- hazy view
• OS- s/p prp stable

Gowri J Murthy
Diagnosis
• OD- Absolute NVG, PDR s.p PRP
• OS- regressed NV/ simc, PDR s/p prp, sec OAG

• Treatment options OD
• TSCPC/ Cyclocryotherapy
• Interim medical management- Aq suppressants, topical steroids, cycloplegics.

Gowri J Murthy
Management principles
• Early diagnosis
• Prompt treatment of underlying cause- retinal ischemia
• Consider Intravitreal Antivegf-
• regression of NVI/A,
• prevention of PAS,
• buys time for definitive management,
• lesser complications with glaucoma surgery.
• Interim Medical Management. Avoid PGA/ Pilocarpine
• Definitive surgical management- Trab with MMC, Valves, TSCPC/ECP

Gowri J Murthy

Vous aimerez peut-être aussi