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Klin Monbl Augenheilkd 2023; 240(03): 305-315
DOI: 10.1055/a-1956-9348
Übersicht

Neovascular Glaucoma: An Update

Neovaskuläres Glaukom: ein Update
Dimitrios Kalogeropoulos 
1   Ophthalmology, University General Hospital of Ioannina, Ioannina, Greece
,
George Moussa
2   Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, United Kingdom of Great Britain and Northern Ireland
,
Velota Ct. Sung
2   Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, United Kingdom of Great Britain and Northern Ireland
,
Chrysavgi Pappa
1   Ophthalmology, University General Hospital of Ioannina, Ioannina, Greece
,
Chris Kalogeropoulos
1   Ophthalmology, University General Hospital of Ioannina, Ioannina, Greece
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Abstract

Neovascular glaucoma (NVG) is a severe type of secondary glaucoma with devastating complications and generally poor visual prognosis. NVG is defined by the development of pathological neovessels over the iris and the iridocorneal angle that can block the outflow of aqueous humor, causing elevation of intraocular pressure (IOP). The pathogenesis of NVG is, in most cases, associated with ischemia of the posterior segment, which is most frequently associated with proliferative diabetic retinopathy or central retinal vein occlusion. The advanced stages of NVG are by iris and angle neovascularization, angle, and extremely high IOP, accompanied by ocular pain and poor vision. The therapeutic approach of NVG is based on the reduction of retinal ischemia by panretinal photocoagulation. Intravitreal anti-VEGF administration can contribute to the regression of neovascularization, and topical and systemic medications may be necessary for IOP control. However, if medical treatment with these agents is not enough, surgical procedures may be required to lower IOP and prevent glaucomatous optic neuropathy. Early and prompt diagnosis, with identification of the underlying etiology, can improve IOP control and final visual outcome. The aim of this study is to review current knowledge of the pathogenesis and management of NVG.

Zusammenfassung

Das neovaskuläre Glaukom (NVG) ist eine schwere Form des sekundären Glaukoms mit verheerenden Komplikationen und allgemein schlechter Prognose für das Sehvermögen. Das NVG ist definiert durch die Entwicklung pathologischer Gefäßneubildungen über der Iris und dem Iridokornealwinkel, die den Abfluss des Kammerwassers blockieren und eine Erhöhung des Augendrucks verursachen können. Die Pathogenese der NVG ist in den meisten Fällen mit einer Ischämie des hinteren Segments verbunden, verursacht ist durch proliferative diabetische Retinopathie oder Zentralvenenverschluss. Die fortgeschrittenen Stadien der NVG sind gekennzeichnet durch Iris- und Kammerwinkelneovaskularisation und -verschluss und extrem hohen Augendruck, begleitet von Augenschmerzen und Sehstörungen. Der therapeutische Ansatz von NVG basiert auf der Reduktion der retinalen Ischämie durch panretinale Photokoagulation. Die intravitreale Verabreichung von Anti-VEGF kann zur Regression der Neovaskularisation beitragen, und topische und systemische Antiglaukommedikamente können für die Augendruckkontrolle erforderlich sein. Wenn jedoch eine medizinische Behandlung mit diesen Mitteln nicht ausreicht, können chirurgische Eingriffe erforderlich sein, um den Augendruck zu senken und einer glaukomatösen Optikusneuropathie vorzubeugen. Eine frühzeitige und schnelle Diagnose mit Identifizierung der zugrunde liegenden Ätiologie kann die Augendruckkontrolle und das endgültige Sehergebnis verbessern. Das Ziel dieser Studie ist es, den aktuellen Wissensstand über die Pathogenese und das Management von NVG zu überprüfen.

Key words

neovascular glaucoma - panretinal photocoagulation - anti-VEGF - glaucoma surgery - diode laser

Schlüsselwörter

neovaskuläres Glaukom - panretinale Photokoagulation - Anti-VEGF - Glaukomchirurgie - Diodenlaser


Publication History

Received: 18 August 2022

Accepted: 27 September 2022

Article published online:
27 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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