13.6.4
Neovascular Glaucoma
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 13, Ophthalmic Conditions.
Clinical Description
Secondary glaucoma where anterior chamber angle is closed by “new” blood vessels
Signs and Symptoms
SIGNS AND SYMPOMS
- Decreased vision, Headache and eye pain, Photophobia
- Corneal oedema, hyphema, vitreous haemorrhage, high IOP
Treatment
- Pan retinal photocoagulation to decrease retinal ischaemic drive.
- Consider intravitreal anti-VEGF therapy (e.g Bevacizumab)
- Reduction of IOP and inflammation
- Medical
- Cycloplegic (e.g. atropine 1% 12 hourly) + frequent topical steroids (e.g. prednisolone acetate 1% 6 hourly) + ocular hypotensive agents as for POAG.
- Surgical
- Tube-shunt procedures (eg Ahmed valve)
- Consider trabeculectomy
- Cyclodestruction (e.g. cyclodiode) if poor visual prognosis.
- Pain control
- Cycloplegia (e.g. atropine 1% 12 hourly)
- Artificial tears
- If the eye is blind and painful, consider retrobulbar injection of absolute alcohol (96%) or chlorpromazine 25mg , or evisceration/enucleation.
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