A 55-year-old man with proliferative diabetic retinopathy develops neovascularisation of the iris and angle. IOP is 48 mmHg. Gonioscopy shows open angles with fibrovascular membrane covering the trabecular meshwork. What is the most appropriate initial management to control IOP in this patient?
- A Intravitreal anti-VEGF injection with aqueous suppressants ✓
- B Topical pilocarpine 2%
- C Laser peripheral iridotomy
- D Trabeculectomy as first-line
Correct answer: A. Intravitreal anti-VEGF injection with aqueous suppressants
Explanation
Neovascular glaucoma secondary to PDR is driven by VEGF-induced neovascularisation causing fibrovascular membrane closure of the trabecular meshwork. Intravitreal anti-VEGF agents rapidly regress iris neovascularisation and are used adjunctively with aqueous suppressants. Trabeculectomy has high failure rates if active neovascularisation is present. Iridotomy and pilocarpine do not address the underlying mechanism.
Reference: American Academy of Ophthalmology Basic and Clinical Science Course, 2023-2024 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.