Abstract
Purpose :
Understanding angle anatomy in patients with neovascular glaucoma (NVG) is crucial for effective treatment. This study assesses the long-term management and treatment outcomes of patients with NVG with open or partially open angles, pre- and post-implementation of a new protocol aiming to preserve physiologic aqueous outflow through the conventional outflow pathway.
Methods :
A retrospective chart review was performed to identify patients with NVG at the University of Chicago Medical Center (2010-2022). Exclusion criteria included <12 months follow-up, completely closed angles at initial diagnosis, and no light perception at baseline. Patients were grouped based on whether they received treatment before or after the implementation of this new strategy, which coincided with the arrival of a new attending (MQ). The new protocol involved six-monthly anti-VEGF injections with interspersed panretinal photocoagulation (PRP). If IOP rose and there was no anterior segment neovascularization, as anticipated with monthly injections, an angle procedure could be performed. In situations where patients faced challenges in completing the interventions or showed a limited response to treatment, the option of tube implantation or cyclophotocoagulation was considered.
Results :
A total of 193 charts were reviewed and 57 eyes of 54 patients were included in the study. Implementation of the new protocol significantly reduced the utilization of filtering glaucoma surgeries and cyclodestructive procedures. In open-angle eyes, there was a notable decrease in glaucoma surgeries with the new protocol (50% vs 6.3%, p=0.018). Although the overall proportion of surgeries for patients with open and partially open angles combined did not show a significant difference (50.0% vs 34.3%, p= 0.239), the new protocol effectively shifted interventions towards angle-based procedures. IOP and visual acuity outcomes were comparable between protocols. Moreover, the proportion of patients maintaining their open angle status after at least one year from initial presentation was significantly higher with the new protocol (p=0.012).
Conclusions :
An angle-based treatment approach to NVG led to reduced utilization of surgeries and comparable IOP and visual acuity outcomes. While limitations exist, this study highlights the potential benefits of angle-based protocols in optimizing NVG treatment.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.