A 58-year-old man with proliferative diabetic retinopathy develops neovascularization of the iris and an intraocular pressure of 48 mmHg in the left eye. Gonioscopy shows open angle with neovascular fronds. Which of the following is the most important initial treatment to address the underlying pathophysiology?
- A Topical timolol and brimonidine
- B Intravitreal anti-VEGF injection ✓
- C Laser peripheral iridotomy
- D Trabeculectomy
Correct answer: B. Intravitreal anti-VEGF injection
Explanation
Neovascular glaucoma results from retinal ischemia driving VEGF-mediated neovascularization of the iris and angle. Intravitreal anti-VEGF (bevacizumab or ranibizumab) rapidly regresses neovascularization and should be given before definitive surgery. Panretinal photocoagulation addresses the ischemic drive. Topical agents lower IOP temporarily but do not treat the cause. Trabeculectomy without addressing active neovascularization has high failure and hemorrhage risk.
Reference: AAO Preferred Practice Pattern: Primary Angle Closure Glaucoma, 2020 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.