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Surgeon: Secondary glaucoma treatment shaped by underlying causes
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LAS VEGAS — The treatment of secondary glaucoma requires an understanding of the underlying causes so that therapies can be tailored to both the reduction of IOP as well as the secondary pathology, according to a presenter here.
Eydie Miller-Ellis, MD, spoke on the various causes of secondary glaucoma at the OSN Las Vegas meeting.
Underlying causes include pseudoexfoliation, pigment dispersion syndrome, steroid-induced pressure spikes, lens-induced pressure spikes, trauma, uveitis and neovascularization, Dr. Miller-Ellis said.
"There is overlap in medical and surgical therapy for secondary and primary glaucomas, and there are diagnosis-specific interventions," she said.
One of the newest therapeutic interventions is aimed at neovascular glaucoma due to retinal ischemia. The most common causes of this condition are proliferative diabetic retinopathy, central retinal vein occlusion and carotid artery occlusive disease.
Because several angiogenesis factors have been identified with these pathologies, the off-label use of anti-VEGF agents has emerged as a promising treatment option, Dr. Miller-Ellis said.
"Anti-VEGF agents are the newest, most specific intervention for neovascular glaucoma," she said. "These agents, alone or in combination with PRP [panretinal laser photocoagulation], decrease anterior segment neovascularization."
Dr. Miller-Ellis explained that, if the angle is open, IOP may improve after regression of the fibrovascular membrane. If the angle is closed, neovascular regression decreases hemorrhagic risk, as well as the risk of inflammation that can accompany glaucoma surgical procedures.