The mechanism and therapeutic strategies for neovascular glaucoma secondary to diabetic retinopathy

Abstract

Neovascular glaucoma (NVG) is a devastating secondary glaucoma characterized by the appearance of neovascular over the iris and the proliferation of fibrovascular tissue in the anterior chamber angle. Proliferative diabetic retinopathy (PDR) is one of the leading causes of NVG. Currently increasing diabetes population drive the prevalence rate of NVG into a fast-rising lane. The pathogenesis underlying NVG makes it refractory to routine management for other types of glaucoma in clinical practice. The combination of panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (VEGF) injections, anti-glaucoma drugs, surgical intervention as well as blood glucose control is needed. Early diagnosis and aggressive treatment in time are crucial in halting the neovascularization process and preserving vision. This review provides an overview of NVG secondary to diabetic retinopathy (DR), including the epidemiology, pathogenesis and management, so as to provide a better understanding as well as potential therapeutic strategies for future treatment.

Potential application of Klotho as a prognostic biomarker for patients with diabetic kidney disease: a meta-analysis of clinical studies

“…15,17,46 Similarly, reduced Klotho may also be involved in the pathogenesis of DM and its complications. 47 In murine models with DM, klotho knockdown increased β-cell apoptosis and exacerbated glucose intolerance and hyperglycemia. 48,49 On the contrary, klotho transfer or systemic Klotho therapy increased β-cell replication and ameliorated diabetes.…”

“… 15 , 17 , 46 Similarly, reduced Klotho may also be involved in the pathogenesis of DM and its complications. 47 …”

Oxidative Stress and Its Regulation in Diabetic Retinopathy

“…Proliferative diabetic retinopathy is one of the leading causes of neovascular glaucoma, a secondary glaucoma that represents end-stage disease and is characterized by severe eye pain and extremely high intraocular pressure [ 70 ]. This complication is very difficult to manage and, depending on the visual prognosis, may require glaucoma drainage surgery, cyclodestructive procedures, or in the case of a blind painful eye, evisceration or enucleation.…”

Management of Neovascular Glaucoma

“…In the United States, diabetic retinopathy is the most common cause, representing about 50% of cases. 19 In general, the 3 most common etiologies of NVG, which comprise the vast majority of NVG cases, are diabetic retinopathy (33%), ischemic retinal vein occlusion (33%), and ocular ischemic syndrome (13%). 4,20,21 Classically described as "90-day glaucoma," a relatively high proportion of NVG occurs within the first 3 to 4 months after an ischemic central retinal vein occlusion (CRVO).…”

“…The prevalence of NVG varies based on country and region of the world. In the United States, diabetic retinopathy is the most common cause, representing about 50% of cases 19 . In general, the 3 most common etiologies of NVG, which comprise the vast majority of NVG cases, are diabetic retinopathy (33%), ischemic retinal vein occlusion (33%), and ocular ischemic syndrome (13%) 4,20,21 .…”