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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 31  |  Issue : 2  |  Page : 172

Neovascular glaucoma


Department of Cataract and Glaucoma, Giridhar Eye Institute, Kochi, Kerala, India

Date of Web Publication27-Aug-2019

Correspondence Address:
Dr. Seshadri J Saikumar
Department of Cataract and Glaucoma, Giridhar Eye Institute, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_39_19

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How to cite this article:
Saikumar SJ, Anup M, Nair A. Neovascular glaucoma. Kerala J Ophthalmol 2019;31:172

How to cite this URL:
Saikumar SJ, Anup M, Nair A. Neovascular glaucoma. Kerala J Ophthalmol [serial online] 2019 [cited 2019 Sep 20];31:172. Available from: http://www.kjophthal.com/text.asp?2019/31/2/172/265500



Dear Sir,

We would like to thank Reesha KR[1] for the showing interest in going through our article and raising the issue of intracameral anti-vascular endothelial growth factor (VEGF) injections.

The main cause of anterior-segment neovascularization in neovascular glaucoma (NVG) is posterior-segment ischemia. Retinal ischemia triggers the release of angiogenic factors such as VEGFs which lead to neovascularization of retina, iris, and angle. In the management of NVG, it is important to treat the underlying ischemic changes in the retina. Intravitreal anti-VEGFs reduces the posterior-segment ischemia and inhibits the release of angiogenic factors which cause regression of existing new vessels and prevent further neovascularization.[2] Vitreous body serves as a reservoir for anti-VEGFs and ensures prolonged effect of anti-VEGF agents. Therefore, vitreous is the preferred location for anti-VEGF injections in NVG. Furthermore, data from literature have shown that monthly intravitreal injection for several months is safe for the retina and anterior segment. However, intravitreal injections need an anterior-chamber paracentesis to reduce sudden increase in intraocular pressure (IOP) which can place the optic nerve at further risk of damage.

On the other hand, intracameral anti-VEGFs will not cause sudden increase in IOP,[3] can be performed in the presence of media opacities, can safe to corneal endothelium, and have fewer vitreoretinal complications. However, intracameral injection shows shorter half-life and duration of effect than intravitreal injection.[2] In addition, as the drug cannot diffuse into the posterior segment, intracameral injections will not reduce the retinal ischemia and release of angiogenic factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Reesha K R. Neovascular glaucoma. Kerala J Ophthalmol 2019;31:81.  Back to cited text no. 1
  [Full text]  
2.
Tolentino M. Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol 2011;56:95-113.  Back to cited text no. 2
    
3.
Puthenparambil L, He YG. Front or back? Intracameral vs. intravitreal injection of bevacizumab for neovascular glaucoma. Invest Ophthalmol Vis Sci 2013;54:214.  Back to cited text no. 3
    




 

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