Updates in the treatment of neovascular glaucoma: From conventional approaches to novel therapies

Neovascular glaucoma (NVG) is a severe and refractory form of secondary glaucoma characterized by the proliferation of abnormal vessels in the anterior segment, leading to a progressive rise in intraocular pressure (IOP) and optic nerve damage. It is most commonly associated with ischemic retinal conditions such as diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome. This review aims to provide an updated overview of the current management strategies for NVG, including recent advancements in medical, laser, and surgical treatment modalities. While anti-vascular endothelial growth factor (VEGF) agents have revolutionized early NVG management, panretinal photocoagulation (PRP) remains the cornerstone of ischemia management, with enhancements in laser delivery improving efficacy and safety. Filtration surgeries like trabeculectomy and glaucoma drainage devices offer equivocal results in NVG, and on the other hand, safer cyclodestructive methods like transscleral micropulse and endoscopic cyclophotocoagulation (ECP) have emerged as promising alternatives with reduced complications. The management of NVG requires a multimodal approach involving the primary physician, retina specialist, and a glaucoma specialist with treatment tailored to disease severity and underlying retinal pathology. Further research is needed to optimize treatment algorithms and explore emerging therapies for this challenging condition.