Abstract
Purpose :
Many medical and surgical therapies exists for neovascular glaucoma (NVG), but their efficacies largely depend on the anterior chamber angle anatomy, with open angles more responsive to medical or angle-based therapies as compared to synechially closed angles. However, little data on this topic exists, so this case series was created to describe the angle status of NVG eyes on presentation.
Methods :
A retrospective chart review was performed for all NVG patients, identified via a SlicerDicer search of the electronic medical record from 2010-2022, with a gonioscopy at the time of presentation. Complete angle closure was defined as having >75% peripheral anterior synechiae (PAS), partial angle closure as having 1-75% PAS, and open angles as having 0% PAS.
Results :
Of 206 patients with a diagnosis of NVG, 134 patients (68 men, 66 women, mean 65.6 years) had a gonioscopy performed at the time of presentation and were included in the analysis. Underlying etiologies included PDR (N=70), RVO (N=40), chronic RD (N=10), RAO (N=9), OIS (N=3), radiation retinopathy (N=1), and idiopathic (N=1). Presenting IOP was 33mmHg in 32 eyes (23.9%), 44mmHg in 43 eyes (32.1%), and 49mmHg in 59 eyes (44%) with open, partially closed, and completely closed angles, respectively. In the three aforementioned groups, presenting best corrected visual acuity (BCVA) was between 20/20 to 20/40 in 47%, 16%, and 0% of eyes, and was between CF to NLP in 16%, 47%, and 91% of eyes, respectively. The proportion of eyes that were phakic and that presented to the emergency room setting (instead of outpatient clinic setting) were 47% and 6%, 47% and 19%, and 64% and 24% in open, partially closed, and completely closed angles, respectively.
Conclusions :
This case series describes the angle status amongst patients presenting with NVG, with nearly half with effectively total synechial angle closure, one-third with partially closed angles, and a quarter with completely open angles. While there is a trend towards higher IOPs and worse BCVAs in eyes with increasing degrees of angle closure, all groups exhibited a wide range of IOPs and BCVAs. Eyes with closed angles also trended towards being phakic, presenting to the ED, and being new patients. Future prospective studies are needed to determine the optimal multidisciplinary treatment plan in NVG eyes, which may differ according to the angle anatomy, rendering a gonioscopic exam essential.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.