What is the best way to treat neovascular glaucoma?

Neovascular glaucoma is not a neonatal disease, but refers to the presence of new blood vessels on the iris of the human eyeball. Once the disease occurs, the patient will feel severe eye pain and be afraid of light. So, how should neovascular glaucoma be treated?

Neovascular glaucoma is the most serious complication of many fundus diseases in the late stage, such as retinal vein obstruction, diabetic retinopathy, long-term retinal detachment, certain intraocular tumors, and chronic intraocular inflammation. This is the most difficult eye disease for ophthalmologists. In the past, most of the methods were cryotherapy, or even retrobulbar injection of anhydrous alcohol or enucleation. Since the launch of anti-VEGF, Avastin and Lucentis (ranibizumab), the treatment of neovascular glaucoma has undergone a revolutionary change. That is, intraocular injection of anti-VEGF drugs! The injection can shrink the new blood vessels in the iris, so the intraocular pressure of some patients can be reduced. For most patients whose intraocular pressure is still high, trabeculectomy can be performed as soon as possible to lower the intraocular pressure and buy time to preserve vision and treat fundus diseases.

Neovascular glaucoma is like a devastating fire. If you slack off for a moment, the damage to your visual function will be devastating. The injection of anti-neovascular drugs is to put out the "fire" first, that is, shrink the new blood vessels, so as to provide the possibility of lowering intraocular pressure surgery and further treating fundus diseases, that is, to eliminate the "fire source". If the intraocular pressure is not lowered in time, and the optic nerve atrophies, it will be too late.

It should be emphasized that the use of anti-VEGF drugs can shrink new blood vessels, which is called "stirring the boiling water to stop it from boiling". After that, the cause must be treated. Most patients are caused by retinal ischemia, so comprehensive and thorough fundus laser treatment is required. If the fundus cannot be lasered due to cataracts or fundus hemorrhage, cataract or vitrectomy surgery is also required to see the fundus clearly before laser treatment. This is called "removing the firewood from under the pot."

Even if the new blood vessels shrink, if the intraocular pressure is still high, trabeculectomy or glaucoma valve implantation can be performed. For some patients who have vision loss, ciliary body laser photocoagulation or ciliary body cryotherapy can be used.

I have to say one more thing here. Many cases of neovascular glaucoma are caused by the patients not taking their disease seriously enough. Some are very young, but when they come to me, they are almost blind and there is no way to save them. Some patients have been using mannitol infusion to lower their intraocular pressure, and some have systemic complications, such as kidney damage. It's a pity!