Neovascular glaucoma (NVG) most commonly develops secondary to which condition, and which part of the drainage angle does iris neovascularisation (rubeosis iridis) first appear?

• A Acute PACG; in the pupillary zone of the iris
• B Uveitis; in the angle first, then progressing centrally
• C Advanced POAG; at the angle only, sparing the iris surface
• D Proliferative diabetic retinopathy or CRVO; at the pupillary margin first, then the angle ✓

Explanation

NVG most commonly follows ischaemic CRVO and proliferative diabetic retinopathy (PDR) — the 90-day rule applies to CRVO (NVG appears ~3 months after ischaemic CRVO). Rubeosis iridis characteristically begins at the pupillary margin (earliest, most sensitive location to detect with slit-lamp and gonioscopy) and progresses circumferentially towards the angle. When neovascular membranes cover the angle, they contract causing peripheral anterior synechiae (PAS) and secondary angle-closure. Treatment includes pan-retinal photocoagulation (PRP) to regress neovascularisation and intravitreal anti-VEGF as bridge therapy before PRP.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.