Kerala Journal of Ophthalmology

: 2019  |  Volume : 31  |  Issue : 2  |  Page : 172-

Neovascular glaucoma

Seshadri J Saikumar, Manju Anup, Abhilash Nair 
 Department of Cataract and Glaucoma, Giridhar Eye Institute, Kochi, Kerala, India

Correspondence Address:
Dr. Seshadri J Saikumar
Department of Cataract and Glaucoma, Giridhar Eye Institute, Kochi, Kerala

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

How to cite this URL:
Saikumar SJ, Anup M, Nair A. Neovascular glaucoma. Kerala J Ophthalmol [serial online] 2019 [cited 2020 May 31 ];31:172-172
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Full Text

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.

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Conflicts of interest

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1Reesha K R. Neovascular glaucoma. Kerala J Ophthalmol 2019;31:81.
2Tolentino M. Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol 2011;56:95-113.
3Puthenparambil L, He YG. Front or back? Intracameral vs. intravitreal injection of bevacizumab for neovascular glaucoma. Invest Ophthalmol Vis Sci 2013;54:214.