| Abstract [eng] |
The aim of this study was to review and evaluate the clinical features, diagnostic challenges and treatment options of neovascular glaucoma based on scientific literature and a clinical case presentation. Methods: A literature review was performed using PubMed and Google Scholar databases. English language articles on the etiology, clinical features, diagnostics, and treatment of neovascular glaucoma were selected. The clinical case of a patient treated for neovascular glaucoma at the Vilnius University Hospital Santaros Klinikos, Centre for Eye Diseases, was analysed. This involved evaluating the patient's clinical findings, intraocular pressure changes, examination results and treatment. Results: Neovascular glaucoma most commonly develops in the setting of retinal ischemia, particularly in proliferative diabetic retinopathy. The disease is characterised by iris and anterior chamber angle neovascularization, leading to fibrovascular membrane formation and irreversible angle closure, resulting in significantly elevated intraocular pressure, progressive optic disc atrophy and deterioration of visual function. In advanced stages, the disease may progress to a painful blind eye. Diagnosis and assessment of disease progression may be complicated by coexisting retinal pathology; therefore, both structural and functional examinations are necessary. The main principles of treatment include reduction of intraocular pressure and suppression of the ischemic stimulus, combining medical, laser and surgical methods. In refractory cases, even maximum multimodal treatment may be insufficient to achieve adequate long-term intraocular pressure control, representing one of the biggest clinical challenges in managing this disease. In the analysed clinical case, neovascular glaucoma developed in the setting of long-standing type 2 diabetes mellitus and advanced proliferative diabetic retinopathy. Iris neovascularization was observed in both eyes, along with elevated intraocular pressure, ischemic fundus changes and significant visual field defects. A multimodal treatment approach was applied, including topical and systemic medical therapy, vascular endothelial growth factor inhibitor therapy, panretinal photocoagulation and transscleral cyclophotocoagulation; however, due to the refractory nature of the disease, despite maximum medical therapy and three cyclophotocoagulation procedures, intraocular pressure control remained inadequate and treatment efficacy was limited. Conclusions: Neovascular glaucoma is a severe, rapidly progressive and refractory form of secondary glaucoma. Diagnosis is complicated by coexisting retinal pathology, which distorts structural examination results and limits the reliability of functional tests. Treatment is challenging due to resistance to medical therapy in advanced stages, the need for surgical interventions and limited long-term efficacy. Early diagnosis of proliferative diabetic retinopathy, regular follow-up and timely treatment may reduce the risk of disease progression and vision loss. |
