October 2017 Vol. 5 No.10

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Original Research Article

Therapeutic options in secondary neovascular glaucoma

D. M. Stanilă^1,2,3, Alina-Adriana Panga^1,3* and Adriana Stanilă^1,2,3

¹Clinical Emergency County Hospital Sibiu,
²Faculty of Medicine, “Lucian Blaga” University of Sibiu
³Ocular Surface Research Center Sibiu

*Corresponding Author’s E-mail: aliapaly@yahoo.com
Tel. +40740407918

Accepted October 13, 2017

Abstract

Neovascular glaucoma is a severe type of secondary glaucoma caused by a variety of disorders, most common being diabetic retinopathy, central or branch vein occlusion or vascular ischemic syndrome, and is characterized by fine arborizing blood vessels on the surface of the iris, pupil margin, and trabecular meshwork, which are accompanied by a fibrous membrane. The aim of the study is to show different methods of treatment and follow-up in neovascular glaucoma. We studied a number of 40 cases with neovascular glaucoma caused by the following conditions: diabetic retinopathy, central vein occlusion and ocular ischemic syndrome. In all cases, there was performed trabeculectomy with antimetabolites (Mitomycin C, 5-Florouracil), and antifibrotic agent Interferon alfa-2b. Beside this surgical procedure, we associated panretinal photocoagulation and intravitreal injection with Bevacizumab. In most cases we managed to preserve the remaining vision and reduce the pain, and there were no cases in which evisceration were needed. Interferon was useful in preserving the filtering bleb. Neovascular glaucoma is a very difficult pathology and is very hard to manage. To avoid complete irreversible visual loss of side, the treatment should begin very early. The use of panretinal photocoagulation and intravitreal injection can reduce the neovascularization of the iris and normalize the IOP. Surgery with antimetabolites and antifibrotic agents is important to avoid the bleb fibrosis, and in most of the cases the IOP was preserved for a long period of time.

Keywords: Neovascular glaucoma, Iris neovascularization, Trabeculectomy, Interferon alfa-2b