Clinical Findings, Diagnosis and Treatment of Neovascular Glaucoma

Year 2025, Volume: 20 Issue: 2, 168 - 174, 21.07.2025

Selma Urfalıoglu , Mervenur Yılmaz , Bayram Alış

Abstract

Neovascular Glaucoma (NVG) is a severe type of secondary glaucoma that occurs as a result of aggressive iris neovascularization. Angiogenic factors secreted to provide vascularization again from hypoxic retinal areas caused by chronic and diffuse retinal ischemia are blamed, especially vascular endothelial growth factor (VEGF). This developing neovascularization (NV) leads to trabecular meshwork dysfunction, progressive angle closure, and high intraocular pressure (IOP), which rapidly causes glaucomatous optic atrophy. Although central retinal vein occlusion and diabetic retinopathy are often indicated as the underlying causes in the diagnosis of NVG in the clinic, it can be seen in intraocular pathologies resulting in retinal ischemia. In the clinic, it may come from the symptom-free stage with a wide range of complaints, such as red eyes, photophobia, blurred vision, and severe eye pain. It has been observed that NVG consists of asymptomatic rubeosis iridis stage, secondary open and closed angle glaucoma stages. In addition to posterior segment examination, anterior segment examination and gonioscopy are important in diagnosing NVG. Gonioscopy plays an important role in showing synechiae in the fibrovascular membrane and angle at every stage, especially at the last stage. NVG treatment involves a challenging process that must be planned in such a way as to require the cooperation of both retinal and glaucoma specialists. The aim is to reduce both retinal ischemia and intraocular pressure (IOP), which rises according to the stages of the disease. Panretinal photocoagulation and anti-Vascular Endothelial Growth Factor (VEGF) are effective in reducing retinal ischemia, while medical and surgical treatment are used to reduce IOP.

Keywords

anti-vegf , intraocular pressure , neovascularization of iris , retinal ischemia , panretinal photocoagulation

Neovasküler Glokomda Klinik Bulgular, Tanı ve Tedavi

Abstract

Neovasküler Glokom (NVG) agresif iris neovaskülarizasyonu sonucu ortaya çıkan şiddetli bir sekonder glokom türüdür. Kronik ve diffüz retina iskemisinin yol açtığı hipoksik retina alanlarından tekrar vaskülarizasyonu sağlama amacı ile salgılanan anjiogenik faktörler özellikle vasküler endotelyal growth faktör (VEGF) sorumlu tutulmaktadır. Gelişen bu neovaskülarizasyon (NV), trabeküler ağ disfonksiyonuna, progresif açı kapanmasına ve yüksek göz içi basıncına (GİB) yol açarak hızla glokomatöz optik atrofiye neden olur. Santral retinal ven oklüzyonu ve diyabetik retinopati klinikte NVG tanısında sıklıkla altta yatan neden olarak gösterilse de; retinal iskemiyle sonuçlanan göz içi patolojilerinde görülebilmektedir. Klinikte semptomsuz evreden, kırmızı göz, fotofobi, bulanık görme ve şiddetli göz ağrısı gibi geniş bir yelpazede şikayetle gelebilir. NVG’un asemptomatik rubeozis iridis evresi, sekonder açık ve kapalı açılı glokom evrelerinden oluştuğu gözlemlenmiştir. NVG tanısında arka segment muayenesinin yanında, ön segment muayenesi ve gonyoskopi önem taşımaktadır. Gonyoskopi her evrede özellikle son evrede fibrovasküler membran ve açıdaki sineşilerin gösterilmesinde önemli rol oynamaktadır.
NVG tedavisi hem retina hem de glokom uzmanlarının işbirliğini gerektirecek şekilde planlanması gereken zorlu bir süreç içerir. Amaç, hem retina iskemisini azaltmak hem de hastalığın evrelerine göre yükselen göz içi basıncını (GİB) düşürmektir.
Panretinal fotokoagülasyon ve anti-Vasküler Endotelyal Growth Faktör (VEGF), retina iskemisini azaltmada etkili iken medikal ve cerrahi tedavi ile GİB düşüşü sağlamaya çalışılır.

Keywords

anti vegf , göz içi basıncı , iris neovaskülarizasyonu , retinal iskemi , Panretinal fotokoagülasyon

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