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Risk Factors for Surgery or Blindness in Neovascular Glaucoma Eyes Treated with Anti-VEGF Injections by a Retina Specialist

Retina. 2023 Mar 9. doi: 10.1097/IAE.0000000000003780. Online ahead of print.


PURPOSE: To determine baseline patient characteristics that predict need for glaucoma surgery or blindness in eyes with neovascular glaucoma (NVG) despite intravitreal anti-vascular endothelial growth factor (VEGF) therapy.

METHODS: Retrospective cohort study of patients with NVG who had not previously received glaucoma surgery and were treated with intravitreal anti-VEGF injections at the time of diagnosis, from 9/8/11 to 5/8/20 at a large, retina subspeciality practice.

RESULTS: Of 301 newly presenting NVG eyes, 31% required glaucoma surgery and 20% progressed to NLP vision despite treatment. Patients with IOP >35 mmHg (p<0.001), 2 or more topical glaucoma medications (p=0.003), worse than 20/100 vision (p=0.024), proliferative diabetic retinopathy (PDR) (p=0.001), eye pain or discomfort (p=0.010), and new patient status (p=0.015) at the time of NVG diagnosis were at a higher risk of glaucoma surgery or blindness regardless of anti-VEGF therapy. The effect of PRP was not statistically significant in a subgroup analysis of patients without media opacity (p=0.199).

CONCLUSIONS: Several baseline characteristics at the time of presentation to a retina specialist with NVG appear to portend a higher risk of uncontrolled glaucoma despite use of anti-VEGF therapy. Prompt referral of these patients to a glaucoma specialist should be strongly considered.

PMID:36913629 | DOI:10.1097/IAE.0000000000003780

By Nevin Manimala

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