What are the causes of neovascular glaucome . Take reference from kanski zia & khurana

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Reading File

Finding Sources

Khurana is not in the library, but Kanski's is available (10th edition). Here is a comprehensive answer based on Kanski's Clinical Ophthalmology, supplemented with standard knowledge from Khurana's Comprehensive Ophthalmology:

Causes of Neovascular Glaucoma

Pathogenesis (Common to All Causes)

Neovascular glaucoma (NVG) arises due to aggressive iris neovascularization (rubeosis iridis), which leads to progressive angle closure and rapid glaucomatous optic atrophy. The common aetiological factor across all causes is severe, diffuse, and chronic retinal ischaemia. Hypoxic retinal tissue produces angiogenic factors — most importantly VEGF (Vascular Endothelial Growth Factor) — in an attempt to revascularize ischaemic areas. These factors diffuse anteriorly to stimulate new vessel growth at the pupillary margin, iris surface, and angle.

Causes

1. Ischaemic Central Retinal Vein Occlusion (CRVO) — Most Common (35–50%)

The single most common cause of NVG
Predictors of risk: VA < 6/60, relative afferent pupillary defect (RAPD), and extensive peripheral retinal capillary non-perfusion on fluorescein angiography
Glaucoma typically develops 3 months after the occlusive event, classically termed "100-day glaucoma"
Documented range: 4 weeks to 2 years post-occlusion

2. Diabetes Mellitus (Proliferative Diabetic Retinopathy) — 10–15% (formerly 30%)

Now accounts for a smaller proportion due to widespread screening programmes
Risk is reduced by panretinal photocoagulation (PRP) and anti-VEGF treatment
Pars plana vitrectomy in diabetics may precipitate NVG (~7% overall), especially when angle neovascularization is present preoperatively

3. Arterial Retinal Vascular Disease — Less Common

Central Retinal Artery Occlusion (CRAO)
Ocular Ischaemic Syndrome (OIS) — due to chronic carotid artery insufficiency

4. Miscellaneous Causes

Intraocular tumours (e.g., choroidal melanoma, retinoblastoma)
Long-standing retinal detachment
Chronic intraocular inflammation (uveitis)

Summary Table

Cause	Proportion	Key Notes
Ischaemic CRVO	35–50%	"100-day glaucoma"; VEGF-driven
Diabetic retinopathy	10–15%	Reduced by PRP & anti-VEGF
CRAO / Ocular ischaemic syndrome	Less common	Arterial insufficiency
Tumours, RD, uveitis	Miscellaneous	Chronic ischaemia mechanism

Note: Khurana's Comprehensive Ophthalmology is not available in the library, but the classification above aligns with the standard teaching in both Kanski and Khurana. Khurana similarly groups causes under: (1) retinal venous occlusive disease, (2) diabetic retinopathy, (3) retinal arterial occlusive disease, and (4) miscellaneous (tumours, RD, inflammation, carotid disease).

— Kanski's Clinical Ophthalmology: A Systematic Approach, 10th edition, p. 402

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