1. NEOVASCULAR
GLAUCOMA

2. Secondary Glaucoma due to fibrovascular
membrane on the surface of the iris and the
angle.
 Thrombotic glaucoma, hemorrhagic
glaucoma,
rubeotic glaucoma.


3. 
Nettleship et al noted an association
between Neovascular glaucoma and
diabetes mellitus.

Kurtz described the gonioscopic appearance
of
new vessels at the angle and a fibrovascular
contracted to form PAS in 1937.

The term Neovascular glaucoma was
proposed by Weiss et al in 1963.

4. RUBEOSIS IRIDIS

New vessels arise from the microvascular
bed in the iris and ciliary body.

Appearance as endothelial buds from
capillaries of minor arterial circle as tufts.
Fibrous membrane contains myofibroblasts
that have contractile properties.
 Pulls the posterior pigment layer of the iris
epithelium anteriorly - ectropion uvea
 Pulls the peripheral iris into the chamber
angle producing PAS.


9. PATHOGENESIS
CHRONIC RETINAL ISCHAEMIA
ANGIOGENIC FACTORS RELEASED &
DIFFUSED
NEOVASCULARISATION ON IRIS AND
IN THE ANGLE.
NEOVASCULAR GLAUCOMA

10. CAUSES
Ischaemic Central retinal vein occlusion
 Diabetic Retinopathy
 Retinal detachment
 Chronic uveitis
 Malignant melanoma
 Retinoblastoma
 Cataract excision
 Vitrectomy


11. PRESENTATION

SYMPTOMS
- Sudden pain
- Headache ,vomiting
- Redness
- Watering
- Defective vision
- Photophobia

12. SIGNS
Ciliary injection
 Hazy cornea from epithelial edema
 Deep anterior chamber with moderate flare,
 Hyphema, a small pupil, and new vessels on
the iris and in the angle(Gonioscopy)
 Ectropion uveae
 Fixed dilated pupil
 Raised IOP


13. NORMAL IRIS VESSELS




Uniform size
Radial course
No branching
Located in stroma
NEW VESSELS




Irregular size
Irregular course
Branching
Located on surface

14. TREATMENT
Panretinal photocoagulation
 Goniophotocoagulation
 Intra Vitreal Anti -VEGF
 Mydriatics
 Corticosteroids
 Filtering surgeries
 Cyclodestructive procedures
 Enucleation


15. PANRETINAL PHOTOCOAGULATION
Performed by reducing stimulus for new
vessel formation.
in Diabetic retinopathy & Ischaemic CRVO.
 200 -500 um spot size , 1500 -2000 burns
 Use of Argon laser
 To prevent the onset of NVG.


17. GONIOPHOTOCOAGULATION
Useful adjunct to panretinal
photocoagulation.
 Performed directly to NVI before
development of NVG ,Absence of synechia.
 Low-energy argon laser treatments (0.2
seconds, 50-100 um, 100 - 200 mW) are
applied to the neovascular tufts as they cross
the scleral spur.


18. INTRAVITREAL ANTI - VEGF
Bevacizumab (Avastin) at dose of 1.25 mg
/0.05 ml .
 It inhibits the VEGF – receptor interaction
and blocks vascular permeability and
angiogenesis.


19. FILTRATION SURGERIES
Good visual potential,IOP not reduced by
medical treatment and if the neovascular
membrane has regressed.
 To prevent pressure –induced injury to optic
nerve and improve vascular perfusion.
 To control pressures and preserve vision.


20. MEDICATIONS
Mydriatics
 Corticosteroids
 Topical beta blocker
 Carbonic anhydrase inhibitor


21. CYCLODESTRUCTIVE PROCEDURES
In painful eyes ,poor visual potential it is
performed to destroy secretory ciliary
epithelium,reduces aqueous secretion.
 Cyclocryotherapy is usually applied at 60
degrees C to 80 degrees C, using a large-tip
probe with its anterior edge 2.5 mm posterior
to the limbus. Six to eight 60-second freezes
are placed over half of the circumference of
the ciliary body.


23. LASER CYCLOABLATION

12-24 burn spots ,posterior to limbus over
360 degrees , 1500-2000 MW, 1.5-2 secs.

24. REFERENCES
1. Becker – Shaffer Diagnosis and therapy of
the glaucomas , 8 th edition.
2. American academy of Ophthalmology
,Glaucoma , Section 10 , 2011-12.
3. Jack J Kanski and Brad Bowling , Clinical
Ophthalmology ,7 th edition.

25. THANK YOU