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Neovascular glaucoma: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Neovascular glaucoma is a secondary closed-angle form of glaucoma. Initially, a fibrovascular membrane grows over the trabecular meshwork. The angle is open but blocked. Over a short period of time, the fibrovascular membrane contracts and closes the angle of the anterior chamber, causing a very high rise in intraocular pressure, usually above 40 mmHg.
[ Epidemiology of neovascular glaucoma
The exact incidence rates of all types of neovascular glaucoma are unknown. Neovascular glaucoma develops as a result of various pathologies, most often after ischemic thrombosis of the central retinal vein and in proliferative diabetic retinopathy. Other predisposing factors include ischemic occlusions of the central retinal artery, ocular ischemic syndrome, thrombosis of the branch retinal arteries and veins, chronic uveitis, chronic retinal detachments, and radiation therapy. Studies of central retinal occlusion (CRVO) provide some of the best reports on the incidence of neovascular glaucoma. Approximately one-third of all CRVOs are ischemic in etiology. Ischemic CRVOs account for 16% to 60% of cases of iris neovascularization, depending on the prevalence of capillary nonperfusion. Approximately 20% of cases of proliferative diabetic retinopathy develop neovascular glaucoma. In 18% of cases with central retinal artery occlusion, neovascularization of the iris develops. All eyes with neovascularization of the iris are at high risk for developing neovascular glaucoma.
Symptoms of neovascular glaucoma
The disease may be asymptomatic in patients or with complaints of pain, redness of the eye and decreased vision.
Diagnosis of neovascular glaucoma
Slit lamp
Due to increased intraocular pressure, corneal edema develops in the anterior chamber. The anterior chamber is usually deep, with a slight opalescence of its moisture. Hyphema is rare, sometimes leukocytes are present. Thin and non-radial vessels are visible on the iris.
Gonioscopy
In the early stages of the disease, with a transparent cornea, gonioscopy reveals a vascular network in the area of the anterior chamber angle. Later, wide anterior peripheral synechiae can be seen, covering some or all of the angle.
Posterior pole
Changes at the posterior pole are consistent with the underlying disease.
Treatment of neovascular glaucoma
Drug treatment usually does not control intraocular pressure. Surgery is usually necessary. The following surgeries are performed: trabeculectomy with an antimetabolite drug, drainage implantation, and cyclodestructive procedures.