SEP 03, 2019
This retrospective cohort study identified risk factors for the development of neovascular glaucoma after acute central retinal vein occlusion (CRVO).
Researchers assessed 98 patients diagnosed with CRVO between 2013 and 2017. These patients did not have anterior segment neovascularization or receive prior anti-VEGF therapy.
Thirteen patients developed neovascular glaucoma. On average, the time from CRVO onset to NVG diagnosis was 212 days. Similar to earlier studies, significant risk factors for glaucoma included the presence of worse baseline visual acuity (P=0.034), a relative afferent pupillary defect (P=0.002) and a history of systemic hypertension (P=0.026). Factors such as age, BMI, history of glaucoma or diabetes and central retinal thickness did not correlate with glaucoma progression.
This is a retrospective study and patients received variable treatment regimens. The number of CRVO patients who met inclusion criteria and developed neovascular glaucoma during this time period (13 eyes) was small. This study could not determine why systemic hypertension, but not diabetes, was associated with progression to neovasucular glaucoma. It is not clear whether fluorescein angiography was performed consistently and if the NVG eyes had at least 10 disc diameter areas of nonperfusion, meeting the CVOS study criteria for ischemic CRVO.
Patients with CRVO must be watched closely for development of vision-threatening neovascular glaucoma. This complication can develop many months after diagnosis (14 months) or after last injection (7 months). Those with an afferent pupillary defect, worse baseline visual acuity and hypertension should be monitored closely for glaucoma. Physicians should monitor for neovascularization of the iris or angle at each visit. Since patients treated with anti-VEGF therapy can still develop neovascular glaucoma, they should be informed of and monitored for this condition.