Glaucoma
Neovascular Glaucoma
Also known as: neovascular glaucoma, NVG, rubeosis iridis, rubeosis irides, iris neovascularisation, NVI, angle neovascularisation, NVA
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Retinal ischaemia releases growth factors that drive new vessels onto the iris and into the drainage angle. A fine fibrovascular membrane first covers the open angle, then contracts and closes it with synechiae. The pressure is normal early and can become very high late. The usual causes are an ischaemic retinal vein occlusion and proliferative diabetic retinopathy; ocular ischaemic syndrome is another. The new vessels can appear weeks to years after the ischaemic event. Early disease has no symptoms, so it is found only by looking at the undilated pupil margin and the angle. New vessels on the iris or in the angle are a same-day referral at any pressure.
Recognition
Symptoms: what patients report
- None in the early stage
- Later: a sore, painful red eye
- Blurred vision, with haloes when the cornea is oedematous
- Poor vision from the underlying retinal disease
Signs: what the examination shows
- Early: fine new vessels on the surface of the iris at the pupil margin, seen before dilation at high magnification
- Later: vessels spreading radially across the iris towards the angle
- Gonioscopy: fine vessels crossing the angle, running perpendicular to the iris contour
- Peripheral anterior synechiae and progressive angle closure in later stages
- Pressure normal early; raised, often markedly, once the angle closes
- Late: corneal oedema, conjunctival injection, ectropion uveae, anterior chamber flare or blood
- Signs of the cause in the fundus: vein occlusion, proliferative diabetic retinopathy or ocular ischaemia
What OptoGuide™ covers for neovascular glaucoma
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting