Essentials in Ophthalmology Series Editor: Arun D. Singh Mary Qiu   Editor Neovascular Glaucoma Current Concepts in Diagnosis and Treatment Essentials in Ophthalmology Series Editor Arun D. Singh, Cleveland Clinic Foundation Cole Eye Institute Cleveland, OH, USA Essentials in Ophthalmology aims to promote the rapid and efficient transfer of medical research into clinical practice. It is published in four volumes per year. Covering new developments and innovations in all fields of clinical ophthalmology, it provides the clinician with a review and summary of recent research and its implications for clinical practice. Each volume is focused on a clinically relevant topic and explains how research results impact diagnostics, treatment options and procedures as well as patient management. The reader-friendly volumes are highly structured with core messages, summaries, tables, diagrams and illustrations and are written by internationally well-known experts in the field. A volume editor supervises the authors in his/her field of expertise in order to ensure that each volume provides cutting- edge information most relevant and useful for clinical ophthalmologists. Contributions to the series are peer reviewed by an editorial board. More information about this series at https://link.springer.com/bookseries/5332 Mary Qiu Editor Neovascular Glaucoma Current Concepts in Diagnosis and Treatment Editor Mary Qiu Ophthalmology and Visual Science University of Chicago Chicago, IL, USA ISSN 1612-3212 ISSN 2196-890X (electronic) Essentials in Ophthalmology ISBN 978-3-031-11719-0 ISBN 978-3-031-11720-6 (eBook) https://doi.org/10.1007/978-3-031-11720-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents Neovascular Glaucoma: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . 1 Pujan Dave and Pradeep Y. Ramulu Epidemiology of Neovascular Glaucoma . . . . . . . . . . . . . . . . . . . . . . . 5 Saira Khanna and Dolly S. Chang Pathophysiology of Neovascular Glaucoma . . . . . . . . . . . . . . . . . . . . . 11 Qing Wang and Thomas V. Johnson Clinical Diagnosis of Neovascular Glaucoma in the Ophthalmology Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Inas F. Aboobakar and Michael M. Lin Clinical Diagnosis of Neovascular Glaucoma in the Emergency Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Christos N. Theophanous and Katy C. Liu Neovascular Glaucoma in Proliferative Diabetic Retinopathy . . . . . . 37 Jing Shan, Chu Jian Ma, and Catherine Q. Sun Neovascular Glaucoma in Retinal Vein Occlusions . . . . . . . . . . . . . . . 57 Nicholas A. Johnson and Atalie C. Thompson Neovascular Glaucoma in Ocular Ischemic Syndrome . . . . . . . . . . . . 69 Zhuangjun Si and Seenu M. Hariprasad Neovascular Glaucoma in Ocular Inflammatory Disease . . . . . . . . . . 75 Rachel A. Downes and Careen Y. Lowder Neovascular Glaucoma in Chronic Retinal Detachments . . . . . . . . . . 79 Aaron Priluck, Loka Thangamathesvaran, and Ravi Pandit Neovascular Glaucoma in Ocular Tumors and Radiation . . . . . . . . . 87 Matthew P. Nicholas, Annapurna Singh, and Arun D. Singh Treatment Goals in Neovascular Glaucoma . . . . . . . . . . . . . . . . . . . . . 97 Humberto Salazar and Swarup S. Swaminathan Panretinal Photocoagulation for Neovascular Glaucoma . . . . . . . . . . 111 Anna G. Mackin, Nathalie Massamba, and Dimitra Skondra v vi Contents Anti-Vascular Endothelial Growth Factor for Neovascular Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Narine Viruni and Cindy X. Cai Medical IOP-Lowering Therapy for Neovascular Glaucoma . . . . . . . 131 Pathik P. Amin and Mary Qiu Trabeculectomy for Neovascular Glaucoma . . . . . . . . . . . . . . . . . . . . 139 Kevin M. Halenda and Annapurna Singh Aqueous Shunt for Neovascular Glaucoma Implant . . . . . . . . . . . . . . 151 Wesam S. Shalaby, Dilru C. Amarasekera, and Aakriti Garg Shukla Cyclophotocoagulation for Neovascular Glaucoma . . . . . . . . . . . . . . . 167 Michael A. Krause and Jonathan Eisengart Micro-incisional Glaucoma Surgery for Neovascular Glaucoma . . . . 177 Jacob Kanter and Mary Qiu Advancing Care in Neovascular Glaucoma . . . . . . . . . . . . . . . . . . . . . 185 Mary Qiu, Aakriti G. Shukla, and Catherine Q. Sun Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Neovascular Glaucoma: An Overview Pujan Dave and Pradeep Y. Ramulu Neovascular glaucoma (NVG) is an aggressive betes in years to come [2]. A variety of names, secondary glaucoma resulting from iris and ante- including hemorrhagic glaucoma, rubeotic glau- rior chamber angle neovascularization that is coma, and congestive glaucoma, were used to most often triggered by underlying retinal isch- describe this condition until the introduction of emia. Because the etiology of angle neovascular- term “neovascular glaucoma” by Weiss in 1963 ization is often the domain of one ophthalmic based on an improved understanding of the subspecialty (retina), while the manifestation is pathophysiology of the condition [3, 4]. the domain of another (glaucoma), the topic is In contrast to other more common glaucomas both difficult to treat and to discuss academically. (primary open angle, pseudoexfoliation, pigment Also, the subject may not have been previously dispersion, etc.) that have similar approaches to addressed in as much depth as done here based management, NVG requires a unique treatment on historical data demonstrating poor visual out- paradigm involving not only the control of ele- comes in NVG eyes. The current book, which vated IOP, but also the control of pro-angiogenic reviews the causes of NVG, while also updating conditions that promote neovascularization. The us on latest methods of addressing neovascular- management of NVG has evolved significantly ization and safely achieving IOP-lowering, is since its early descriptions as we have discovered therefore a welcome and much-needed new approaches to control retinal ischemia and contribution. surgically manage elevated intraocular pressure. The earliest report of what we now understand Though NVG accounts for a minority of all glau- to be NVG was documented in 1871, which comas, it is aggressive and frequently refractory described an eye with elevated intraocular pres- to medical management, requiring surgical sure (IOP) in the setting of intraocular hemor- intervention. rhage [1]. Decades later in 1906, angiogenesis of An overlooked, but very important, aspect of the iris was histologically described by Coats in a NVG management is close monitoring for its patient with a central retinal vein occlusion development in high-risk patients [5]. While we (CRVO), and similar abnormal vessel growth was as practitioners are often presented with the chal- identified on the iris surface of patients with dia- lenge of treating eyes where NVG has clearly manifested, we less often ask the question of what we might do better to avoid having patients P. Dave · P. Y. Ramulu (*) develop NVG. It is well established that high-risk Wilmer Eye Institute, Johns Hopkins University, patients most commonly include those with isch- Baltimore, MD, USA emic CRVO, diabetic retinopathy, and ocular e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 1 M. Qiu (ed.), Neovascular Glaucoma, Essentials in Ophthalmology, https://doi.org/10.1007/978-3-031-11720-6_1 2 P. Dave and P. Y. Ramulu ischemic syndrome, but, as discussed later in this coma management, and it has not yet been textbook, there are many other conditions in extensively studied whether these novel angle- which NVG can develop. Early recognition and based surgeries would be effective for treatment of underlying etiologies may prevent NVG. Given the revolutionary effect of combi- development of NVG, or arrest and reverse the nation anti-VEGF and PRP treatment on regres- process at its earliest stages. In the past, panreti- sion of neovascularization, some patients with nal photocoagulation (PRP) was the only option NVG may obtain IOP control with MIGS alone for the prevention and treatment of neovascular- as opposed to traditional glaucoma surgery. ization, with variable success depending on the Certainly, aqueous shunts and diode laser CPC underlying condition and timing of the treatment. will remain important for particular cases, but The advent of intravitreal antivascular endothe- angle- based surgeries may modify NVG man- lial growth factor (anti-VEGF) treatment, how- agement in the anti-VEGF era. This book will ever, has drastically changed our approach and also review the most recent data regarding the outcomes, and has become the mainstay of treat- outcomes of procedures that filter aqueous ment alongside PRP for all causes of ocular humor to the subconjunctival space (i.e., trab- neovascularization. eculectomy)—an important question for areas Unfortunately, despite these interventions, of the world where the cost of certain surgical many patients develop high IOP that necessitates implants (i.e., aqueous shunts) may be specific IOP lowering treatment. Medical man- prohibitive. agement includes topical IOP lowering agents Our understanding of NVG and its manage- commonly used for glaucoma management (e.g., ment have progressed tremendously since its first carbonic anhydrase inhibitors, alpha-2 agonists, description in the nineteenth century. The disease etc.) and oral carbonic anhydrase inhibitors when remains difficult to treat in spite of these advances topical treatment is not sufficient. Topical corti- and ocular morbidity from NVG remains high. It costeroids are used in some patients to control is vital to rigorously evaluate both novel and con- intraocular inflammation. When medical man- ventional treatments to optimize management of agement does not lower the IOP enough to pre- this particularly challenging and refractory dis- vent optic nerve damage, which is much more ease. As vascular disease becomes more preva- common with NVG than with other forms of lent, NVG, too, is likely to become more common glaucoma, surgery becomes necessary to control given the associations between vascular disease the IOP. Traditionally, surgical management of and underlying ocular conditions that predispose NVG includes either implantation of aqueous to NVG. Retina and glaucoma specialists must shunts and diode laser cyclophotocoagulation work closely together to treat this condition with (CPC). Historically, trabeculectomy has a rela- a combination of PRP, anti-VEGF, medical IOP- tively high failure rate in NVG even with use of lowering therapy, traditional glaucoma surgery, antimetabolites and is therefore not routinely per- and possibly MIGS, catering to each patient’s formed [6]. individual clinical needs as our understanding of Much of our knowledge about the best surgi- NVG becomes increasingly refined. We welcome cal outcomes for NVG comes from studies that this comprehensive discussion of a very chal- were performed before the routine use of anti- lenging problem, with the goal that we might VEGF medications. Moreover, the arrival and change our practice to prevent and/or detect NVG popularization of micro-incisional glaucoma earlier, and to achieve better outcomes when it surgery (MIGS) have transformed surgical glau- does present. Neovascular Glaucoma: An Overview 3 References 4. Smith RJ.  Rubeotic glaucoma. Br J Ophthalmol. 1981;65(9):606–9. 5. Hayreh SS. Neovascular glaucoma. Prog Retin Eye 1. Gilbert W. Beiträge zur Lehre vom Glaukom. Graefes Res. 2007;26(5):470–85. Arch Ophthalmol. 1912;82(3):389–474. 6. Mietz H, Raschka B, Krieglstein GK. Risk factors for 2. Coats G. Further cases of thrombosis of the central failures of trabeculectomies performed without anti- vein. London: J. & A. Churchill; 1906. metabolites. Br J Ophthalmol. 1999;83(7):814–21. 3. Weiss DI, Shaffer RN, Nehrenberg TR. Neovascular glaucoma complicating carotid-cavernous fistula. Arch Ophthalmol. 1963;69(3):304–7.