Secondary Glaucoma due to fibrovascular
membrane on the surface of the iris and the
Thrombotic glaucoma, hemorrhagic
Nettleship et al noted an association
between Neovascular glaucoma and
Kurtz described the gonioscopic appearance
new vessels at the angle and a fibrovascular
contracted to form PAS in 1937.
The term Neovascular glaucoma was
proposed by Weiss et al in 1963.
New vessels arise from the microvascular
bed in the iris and ciliary body.
Appearance as endothelial buds from
capillaries of minor arterial circle as tufts.
Fibrous membrane contains myofibroblasts
that have contractile properties.
Pulls the posterior pigment layer of the iris
epithelium anteriorly - ectropion uvea
Pulls the peripheral iris into the chamber
angle producing PAS.
CHRONIC RETINAL ISCHAEMIA
ANGIOGENIC FACTORS RELEASED &
NEOVASCULARISATION ON IRIS AND
IN THE ANGLE.
Hazy cornea from epithelial edema
Deep anterior chamber with moderate flare,
Hyphema, a small pupil, and new vessels on
the iris and in the angle(Gonioscopy)
Fixed dilated pupil
NORMAL IRIS VESSELS
Located in stroma
Located on surface
Performed by reducing stimulus for new
in Diabetic retinopathy & Ischaemic CRVO.
200 -500 um spot size , 1500 -2000 burns
Use of Argon laser
To prevent the onset of NVG.
Useful adjunct to panretinal
Performed directly to NVI before
development of NVG ,Absence of synechia.
Low-energy argon laser treatments (0.2
seconds, 50-100 um, 100 - 200 mW) are
applied to the neovascular tufts as they cross
the scleral spur.
INTRAVITREAL ANTI - VEGF
Bevacizumab (Avastin) at dose of 1.25 mg
/0.05 ml .
It inhibits the VEGF – receptor interaction
and blocks vascular permeability and
Good visual potential,IOP not reduced by
medical treatment and if the neovascular
membrane has regressed.
To prevent pressure –induced injury to optic
nerve and improve vascular perfusion.
To control pressures and preserve vision.
In painful eyes ,poor visual potential it is
performed to destroy secretory ciliary
epithelium,reduces aqueous secretion.
Cyclocryotherapy is usually applied at 60
degrees C to 80 degrees C, using a large-tip
probe with its anterior edge 2.5 mm posterior
to the limbus. Six to eight 60-second freezes
are placed over half of the circumference of
the ciliary body.
12-24 burn spots ,posterior to limbus over
360 degrees , 1500-2000 MW, 1.5-2 secs.
1. Becker – Shaffer Diagnosis and therapy of
the glaucomas , 8 th edition.
2. American academy of Ophthalmology
,Glaucoma , Section 10 , 2011-12.
3. Jack J Kanski and Brad Bowling , Clinical
Ophthalmology ,7 th edition.