Neovascular glaucoma
El glaucoma are a group of diseases that cause a progressive damage to the optic nerve and can irreversibly compromise vision. Neovascular glaucoma is a secondary glaucoma very aggressive characterized by growth of new blood vessels in the iris and in the iridocorneal angle.
Neovascular glaucoma is almost always caused by very advanced or poorly controlled type 2 diabetes, but it can also be caused by other conditions such as tumors, blocked arteries, or eye inflammation. neovascular glaucoma does not usually cause symptoms in its initial phase And when the patient presents eye pain or discomfort it is because the disease is already in its most advanced phase.
Neovascular glaucoma
El glaucoma are a group of diseases that cause a progressive damage to the optic nerve and can irreversibly compromise vision. Neovascular glaucoma is a secondary glaucoma very aggressive characterized by growth of new blood vessels in the iris and in the iridocorneal angle.
Neovascular glaucoma is almost always caused by very advanced or poorly controlled type 2 diabetes, but it can also be caused by other conditions such as tumors, blocked arteries, or eye inflammation. neovascular glaucoma does not usually cause symptoms in its initial phase And when the patient presents eye pain or discomfort it is because the disease is already in its most advanced phase.
What is neovascular glaucoma?
Neovascular glaucoma is a type of very aggressive secondary glaucoma which occurs when new blood vessels are born in the iris and in the iridocorneal angle. These new capillaries block the drainage of aqueous humor and as a consequence there is an increase in intraocular pressure (IOP) levels.
La High intraocular pressure, constantly or fluctuating, causes optic nerve fiber damage of the eye, structure in charge of sending the brain the visual information that reaches the retina. When the optic nerve does not work properly, vision is compromised and the patient begins to suffer loss of campor visual
Neovascular glaucoma, like the other types of glaucoma, is a disease that there is no cure and it progresses progressively. In the worst cases, the patient may lose vision completely.
Causes of neovascular glaucoma
The cause of neovascular glaucoma is chronic lack of oxygen (ischemia) in the retina that stimulates the formation of new blood capillaries (neovascularization) to oxygenate it. In this process, new blood vessels also proliferate in the iris (iris neovascularization), which block the trabeculum, block the outflow of aqueous humor and, finally, increase intraocular pressure.
Neovascular glaucoma is the product of an ischemic process that is almost always present caused by diabetes mellitus very advanced or poorly controlled. Diabetes is a degenerative disease that gradually affects the retinal blood vessels, causing a permanent lack of oxygen.
Other causes of neovascular glaucoma may be central retinal vein occlusion, obstructive carotid disease, ocular tumors, retinal detachment or inflammatory processes of the eye.
Symptom
Glaucoma is a silent disease that does not cause symptoms in its initial phase. When the patient presents discomfort or signs of neovascular glaucoma, it is because the disease is in an advanced state.
The symptoms of neovascular glaucoma in its acute phase are:
- Eye pain
- Partial or total loss of vision.
- Corneal edema.
- Pupil deformation.
- Ocular redness
- Congestion in the anterior area of the eye.
Diagnosis
The diagnosis of neovascular glaucoma must be as early as possible to prevent irreversible damage to the optic nerve. For this reason it is important to visit the ophthalmologist regularly to check eye health, especially if you have a history of glaucoma or are diabetic.
To diagnose glaucoma, a comprehensive eye exam. In the case of neovascular glaucoma, small blood vessels in the iris, which is known as rubeosis iridis. In this phase of glaucoma, IOP may still be normal.
If the glaucoma is more advanced Blood vessels can be found in the iridocorneal angle and in the trabecular meshwork, accompanied by elevated intraocular pressure, corneal edema, and loss of visual acuity.
To diagnose neovascular glaucoma we usually carry out the following diagnostic tests:
- Tonometry to measure intraocular pressure.
- Fundus examination to study the optic nerve and determine if there are lesions in its fibers.
- Scanning of the cornea and retina.
- Gonioscopy to assess the status of the drainage angle.
- Campimetry to analyze the campor visual of the patient.
Treatment of neovascular glaucoma
Like the other types of glaucoma, neovascular glaucoma is a disease that there is no cure. Treatment of this condition is aimed at control three fundamental aspects of the disease that are key to the quality of life of the patient: intraocular pressure levels, lack of oxygen in the retina and eye pain.
During the initial phase called rubeosis iridis, the treatment of neovascular glaucoma is the panretinal photocoagulation. This technique is very effective for prevent the disease from progressing and become a secondary angle-closure glaucoma. This procedure is not very invasive, it is performed under the effects of local anesthesia and it allows to eliminate the leakage of blood vessels by applying the action of the laser.
In more advanced stages of neovascular glaucoma, the most indicated treatment is trabeculectomy. This glaucoma surgery consists of making a small incision in the sclera to stimulate drainage of aqueous humor through a filtering bubble that is created in the conjunctiva. If the bubble heals prematurely or fails to drain the aqueous humor, we will evaluate with the patient the possibility of performing a trabeculectomy with a drain valve.
Glaucoma surgery offers excellent results to control this disease but it does not stop the progression of glaucoma. Some patients will have to undergo several surgeries throughout their lives.
Key to success in the treatment of any type of glaucoma is a dis in its initial phase.
