Neovascular glaucoma and methods to combat it

When a person develops a neovascular glaucoma, initially the fibrovascular membrane grows on the trabecular network. The angle remains open, but is blocked. Within a short period of time, the membrane undergoes contractions and begins to close the angle of the anterior chamber, provoking a strong increase in intraocular pressure.

As a rule, the chronic form of diffuse retinal ischemia becomes the causative factor in the development of this form of the disease.

Classification of the disease

Neovascular glaucoma is classified into three stages of development:

1. Rubyosis of the iris. Rubeosis develops as follows: small pencils or nodules of red capillaries are formed along the perimeter of the pupil margin. If the patient is not properly examined, they can be missed. Such vessels grow over the entire surface of the iris, while the intraocular pressure remains at a satisfactory level.
2. Open angle glaucoma secondary type. The vessels continue to expand and tend to reach the root of the iris, after which the neovascular tissue covers the ciliated body and the scleral spur. Vessels begin to branch and form a fibrovascular membrane.   Syndrome closed angle glaucoma secondary type. There is a closing angle around its entire circumference, so the intraocular pressure unexpectedly increases. In this regard, there is a sharp loss of vision and the formation of phenomena of stagnation and pain. This stage is the last stage in the development of neovascular glaucoma. It differs from the other stages with the following symptoms:
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• severe deterioration of visual acuity;
• pain and stagnant injection;
• increased intraocular pressure and a strong edema of the cornea;
• a suspension of blood in the moisture and sweating of the proteins that form part of the newly formed vessels;
• pronounced changes in the shape of the pupil, often accompanied by a reversal due to contractions in the fibrovascular membrane.

Symptoms of pathology

This pathology is often asymptomatic, or patients begin to complain of the presence of pain, redness of the eye and deterioration of the visual organs.

Treatment of

The main objective of the process of treating neovascular glaucoma is to reduce pain, restore the visual organs, although the predictions tend to remain unfavorable. Treatment is carried out in several ways, namely:

1. Medication therapy of neovascular glaucoma should begin with the reception of beta-blockers, the effectiveness of which gradually decreases. The local administration of steroids and atropine helps reduce inflammation. Also, local treatment can remove eye irritation and eliminate the phenomenon of stagnation, even with a high level of intraocular pressure. In that case.when the patient is worried about severe pain, or before the surgery, osmotic diuretics and inhibitors of systemic carbonic anhydrase are used.   
2. Organization of retinal ablation in the development of neovascular glaucoma. The procedure is performed using a laser with adequate visualization of the fundus.
3. Filtration methods of surgery in the defeat of the eye with neovascular glaucoma. This approach is considered as an option when visual acuity remains at a satisfactory level.
4. Transscleral cyclodextraction by laser exposure in neovascular glaucoma is used to restore the normal level of intraocular pressure and to remove signs of eye irritation. It is often used in combination with the patient's medication.
5. Retrobulbaria is used to eliminate pain, but sometimes leads to the omission of the affected eye.
6. Enucleation is a method used by physicians to treat neovascular glaucoma only when there is no effect on other treatments.