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    A clinical perspective of neovascular glaucoma

    Understanding the consequence of pathologic neovascularization of intraocular tissue

    Neovascular glaucoma is a potentially devastating ocular consequence of pathologic neovascularization of intraocular tissue. The symptoms include vision loss caused by both the underlying etiology (such as retinal vascular disease) as well as increased intraocular pressure (IOP), often accompanied by corneal edema, hyphema, or vitreous hemorrhage. Patients may be experiencing a range of ocular pain caused by increased IOP, disruption of corneal surface, and/or mechanical iritis associated with iris neovascularization.

    Signs of the disease include rubeosis or neovascularization of the iris (NVI) that may be noted at the pupillary margin, throughout the mid-iris stroma, or as neovascularization of the angle (NVA) (see Figure 1). Other typical findings are increased IOP, except in cases of carotid artery stenosis (ocular ischemic syndrome) in which IOP may remain in normal range. Corneal haze due to microcystic corneal edema and sub-epithelial bullae may be present due to elevated IOP. Concomitant finding may include anterior peri-lenticular vascularization, ciliary flush, and hyphema (see Figure 2). 

    Pathogenesis of neovascular glaucoma

    Pathologic neovascularization, or formation of new capillaries from preexisting blood vessels, is a common consequence of hypoxia and inflammation. Hypoxia-inducible factor alpha is upregulated in response to decreased tissue oxygen levels. This leads to increased production of vascular endothelial growth factor (VEGF), commonly resulting in neovascularization of ocular tissue following an ischemic event, such as retinal vascular occlusions (see Figure 3). Neovascular tissue may be considered an aberrant healing process, in which excessive proliferation of micro-capillaries results in bleeding, exudation, and fibrovascular scarring. Thus hyphema, vitreous hemorrhage, and edema may be common clinical features. The clinical consequence of fibrovascular scarring may be contraction or mechanical blockage, such as traction retinal detachment or synechial angle closure from neovascularization of the iris (NVI).

    Hottest stories of 2014: Glaucoma


    Mohammad Rafieetary, OD, FAAO
    Dr. Mohammad Rafieetary is a consultative optometric physician at the Charles Retina Institute in Memphis. He is a fellow of the ...
    Eric J. Sigler, MD
    Dr. Sigler is a retina specialist in practice at Ophthalmic Consultants of Lon Island, Division of Retina and Vitreous.


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