New treatment protocol improves outcomes in neovascular glaucoma
Key takeaways:
- Consider angle morphology when treating patients with neovascular glaucoma.
- Comparable visual acuity and IOP and lower rates of filtering and cyclodestructive procedures were seen with the new SCOPING protocol.
A treatment protocol for neovascular glaucoma based on angle anatomy helped improve patient outcomes, according to a study at the American Glaucoma Society meeting.
Jessie Wang, MD, said cases of neovascular glaucoma (NVG) have traditionally been treated the same regardless of angle anatomy.
“At the University of Chicago, we implemented a new treatment protocol known as Salvaging the Conventional Outflow Pathway in Neovascular Glaucoma, or SCOPING, protocol,” she said. “This provides a more standardized approach to managing NVG patients based on angle anatomy.”
The SCOPING protocol consists of six monthly anti-VEGF injections with interspersed panretinal photocoagulation. If a patient’s IOP increases without any anterior segment neovascularization, surgeons perform an angle procedure. In other patients, they use a tube or cyclophotocoagulation, Wang said.
In a retrospective chart review, Wang and colleagues assessed outcomes in 57 eyes of patients with NVG with open or partially open angles before and after implementation of the protocol.
Wang said the SCOPING protocol resulted in comparable visual acuity and IOP control and reduced the use of filtering and cyclodestructive surgeries.
Eyes with completely open angles had fewer surgeries under the new protocol (50% vs. 6.3%, P = .018), and more patients with open and partially open angles underwent angle procedures. Additionally, more eyes maintained an open angle after 1 year, Wang said.
“Angle morphology should be considered in the treatment of NVG patients, and all patients should receive a gonioscopy,” Wang said. “In those with open or partially open angles, the SCOPING protocol resulted in comparable visual acuity and IOP with lower rates of filtering and cyclodestructive procedures.”
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Wang J. Angle-based management of neovascular glaucoma: Evaluating surgical strategies and treatment outcomes in open and partially open angles. Presented at: American Glaucoma Society meeting; Feb. 26-March 2, 2025; Washington (hybrid).
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