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Neovascular Glaucoma Surgery : 15 Yrs Experienced Doctors

Neovascular glaucoma is an aggressive form of secondary glaucoma that can significantly impact vision. Thankfully, advances in medical science have made it possible to effectively treat this condition through surgical procedures. These surgeries aim to reduce intraocular pressure and prevent further damage to the optic nerve. If you or someone you know is facing symptoms of neovascular glaucoma, don't hesitate to book an appointment with our proficient ophthalmologists at Pristyn Care, who are well-versed with the best treatment protocols for neovascular glaucoma.

Neovascular glaucoma is an aggressive form of secondary glaucoma that can significantly impact ... Read More

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What is Neovascular Glaucoma Surgery?

Neovascular glaucoma surgery is a treatment approach for managing neovascular glaucoma, an aggressive form of secondary glaucoma characterised by the proliferation of fibrovascular tissue in the anterior chamber angle. The primary goal of these surgeries is to reduce intraocular pressure (IOP), which, if left uncontrolled, can lead to further damage to the optic nerve, affecting your vision.

Like most medical procedures, these surgeries are performed on an outpatient basis under the supervision of a skilled ophthalmologist. The entire operation aims at regulating the flow of aqueous humour, a fluid present in the eye, and preserving the health of your eyes. Each surgery type has its unique mechanism and effectiveness, and your doctor will recommend the best option based on your medical history and current condition.

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What Are The Types Of Neovascular Glaucoma Surgery?

Several types of surgical interventions are available for treating neovascular glaucoma. Here, we shed light on each one:

  • Trabeculectomy: This common surgical option for neovascular glaucoma involves creating a tiny opening in the sclera (the white part of your eye) to drain out excess aqueous humour, thereby reducing IOP.
  • Glaucoma Drainage Implant (GDI) Placement: In this procedure, a small drainage tube is implanted in the eye to control IOP. GDIs are preferred when there is active neovascularisation, as they are more tolerant of intraoperative and postoperative bleeding.
  • Cyclophotocoagulation: This procedure involves using a laser to destroy the ciliary processes, resulting in reduced aqueous humour production and controlled IOP. This procedure is generally reserved for eyes with poor visual prognosis.
  • Aqueous Shunts: These are devices implanted in the eye to drain excess aqueous humour, thereby reducing IOP. They are often preferred in cases where there is active neovascularisation.
  • Ex-PRESS Glaucoma Shunt: This is a type of aqueous shunt used in treating neovascular glaucoma. It involves implanting a small device that lets excess aqueous humour drain out of the eye, thereby reducing IOP.

Diagnosis Before Neovascular Glaucoma Surgery

Before proceeding with neovascular glaucoma surgery, it’s crucial to diagnose the condition accurately. During diagnosis, your doctor could opt for a combination of clinical evaluation and imaging techniques. Here are some of the common methods used in the diagnosis of neovascular glaucoma (NVG):

  • Clinical Evaluation: Using tools such as slit-lamp biomicroscopy and gonioscopy, early signs of neovascularization can be detected. This is vital in screening for NVG.
  • Fundus Fluorescein Angiography (FFA): Regarded as the gold standard for detecting areas of capillary nonperfusion (CNP) and retinal new vessels (NVE) on the disc (NVD).
  • Anterior Segment Indocyanine Green Angiography: This technique offers detailed images of the vasculature, which can be particularly useful for spotting leakage from new vessels.
  • Optical Coherence Tomography Angiography (OCTA): As a non-invasive imaging technique, OCTA can outline the extent and depth of neovascularization. It is beneficial for follow-up monitoring.

What Is The Procedure For Neovascular Glaucoma Surgery?

Neovascular glaucoma surgery aims to decrease intraocular pressure (IOP) and protect the optic nerve from further damage. The procession differs depending on each patient’s condition and medical history, but generally involves these steps:

  • Trabeculectomy: A small opening is made in the sclera to enable excess aqueous humor to drain out, reducing IOP.
  • Glaucoma Drainage Devices (GDDs): These devices are put into the eye to drain off excess aqueous humor and control IOP.
  • Cyclodestructive Procedures: These involve destroying particular parts in the eye called ciliary processes to minimise aqueous humor production and manage IOP.
  • Ex-PRESS Glaucoma Shunt: This is a specific type of aqueous shunt that drains out excess eye fluid, mitigating IOP.
  • Valve Implant Surgery: A valve is implanted to regulate IOP.

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Who Is The Right Candidate For Neovascular Glaucoma Surgery?

Deciding on neovascular glaucoma surgery depends primarily on the patient’s specific condition and the effects on their daily life. Here are some of the criteria used to ascertain suitability:

  • Progression of Condition: Patients with NVG that have progressed to a severe stage despite medication management may require surgery.
  • Vision Impairment: When vision impairment affects daily activities, despite corrective measures like eyeglasses or contact lenses, surgery might be considered.
  • Insufficient Response to Medication: In cases where IOP is not adequately controlled with medication or laser treatment, surgical intervention could be necessary.

What Are The Benefits Of Neovascular Glaucoma Surgery?

Neovascular glaucoma, a severe type of eye disorder, poses significant threats to vision. However, advancements in medical science have brought forth effective treatment options, such as neovascular glaucoma surgery. Here are a few benefits of this procedure:

  • Reduced Intraocular Pressure (IOP): The primary purpose of the surgery is to lower IOP, preventing further damage to the optic nerve, thereby preserving vision.
  • Improved Visual Prognosis: The surgery aids in controlling IOP and reducing neovascularization, thereby improving long-term visual prognosis for patients with neovascular glaucoma.
  • Prevention of Blindness: Surgical interventions can help manage the aggressive clinical course of neovascular glaucoma and prevent blindness.

How To Prepare For Neovascular Glaucoma Surgery?

As with any operation, preparation is key to achieving the best results from your neovascular glaucoma surgery. Here are some steps you might need to take:

  • Preoperative Panretinal Photocoagulation (PRP): This laser treatment reduces neovascularisation, thus minimising the risk of intraoperative and postoperative haemorrhage.
  • Anti-VEGF Therapy: Adjunct treatment with anti-VEGF agents helps tone down neovascularisation and improve surgical outcomes.
  • Medical Optimisation: Systemic conditions like diabetes and hypertension should be well-managed before surgery.

What Are The Recovery Tips and Precautions To Follow After Neovascular Glaucoma Surgery?

Recovery after neovascular glaucoma surgery requires careful management. Below are some tips and precautions to follow:

  • Frequent Follow-ups: Regular check-ups with your doctor are crucial for monitoring the healing process and adjusting medications as necessary.
  • Medication Compliance: It’s important to strictly adhere to your postoperative medication regimen to minimise the risk of complications.
  • Limit Physical Strain: Avoid heavy lifting, bending, or intense activities for several weeks after surgery to prevent untoward incidents.
  • Eye Safety: Protect the operated eye from injury, and avoid rubbing or touching it unnecessarily.

Potential Risks Or Complications Associated With Neovascular Glaucoma Surgery

While neovascular glaucoma surgery is powerful in managing this eye condition, it’s essential to be aware of potential risks or complications:

  • Bleb Failure: In trabeculectomy surgery, the bleb can fail due to conjunctival scarring at the filtration site, especially if neovascularisation is not substantially resolved.
  • Intraoperative and Postoperative Haemorrhage: Active neovascularisation poses a significant risk for intraoperative and postoperative bleeding.
  • Hypotony and Phthisis: Cyclophotocoagulation can lead to hypotony and phthisis, complications that can compromise vision further.
  • Infection Risk: Like any surgical procedure, there is a risk of infection post-surgery.
  • Vision Loss Risk: Despite surgical interventions, some patients may still experience vision loss due to the aggressive nature of neovascular glaucoma.

What Is The Cost Of Neovascular Glaucoma Surgery In India?

Neovascular glaucoma is a serious condition where new, abnormal blood vessels begin to grow on the iris, the coloured part of your eye. It’s a type of secondary glaucoma that can result in vision loss if not treated properly. Several factors can influence the cost of neovascular glaucoma surgery in India:

  • Type of Surgery: There are different types of neovascular glaucoma procedures such as trabeculectomy, glaucoma drainage implant, and cyclophotocoagulation. Each has its own specific surgical techniques and costs.
  • Surgeon’s Expertise: The best doctors for neovascular glaucoma will have high levels of training and experience which may result in higher treatment costs.
  • Choice of Hospital: Depending on the hospital chosen for the procedure, the cost may vary. Hospitals with advanced facilities may charge more than others.
  • Location: The price can also vary depending on location within India. Metropolitan cities might have a higher cost compared to smaller towns due to higher operating costs.

Is Neovascular Glaucoma Surgery Covered Under Insurance?

Most health insurance plans in India cover glaucoma surgery including neovascular glaucoma procedure. However, the extent of coverage may depend on specific terms and conditions of your policy. Here are some key points about insurance coverage for neovascular glaucoma surgery:

  • Coverage Variability: Different insurance companies provide varying extents of coverage for the treatment of neovascular glaucoma. It’s vital to check with your insurance provider about what’s included and what’s not in your policy.
  • Policy Conditions: Certain restrictions might apply like waiting periods, pre-existing disease exclusions, and co-payment requirements.
  • Type of Surgery: The specific surgery performed may impact the coverage. Hence, it’s crucial to understand which surgeries are covered under your plan.
  • Hospital and Surgeon: The choice of hospital and surgeon can also impact insurance coverage and reimbursement process.

To ensure a successful recovery after neovascular glaucoma surgery, it is recommended to consult with your insurance provider or healthcare facility to understand your insurance plan’s specific inclusions and exclusions. By doing so, you can prepare better for the financial aspect of this life-changing procedure.

FAQs Related to Neovascular Glaucoma

How long does the neovascular glaucoma procedure take?

Typically, a neovascular glaucoma procedure, takes about an hour to complete. However, this can vary depending on the complexity of the case and the individual patient’s health condition.

What are the early symptoms of neovascular glaucoma?

Early symptoms of neovascular glaucoma may be subtle or unnoticed. They might include decreased vision, especially at night or in low light conditions, seeing floaters or spots, and experiencing eye pain or redness.

Can treatment for neovascular glaucoma reverse vision loss?

Unfortunately, treatment for neovascular glaucoma cannot typically reverse any vision loss that has already occurred. The primary aim is to halt further damage and maintain the existing level of sight.

Is there a definitive cure for neovascular glaucoma?

Currently, while treatment can manage the condition and prevent further vision loss, there is no definitive cure for neovascular glaucoma. The condition is chronic and typically requires long-term management.

How long is recovery after neovascular glaucoma surgery?

Recovery after neovascular glaucoma surgery varies from patient to patient. It could take a few weeks to several months to fully recover, depending on the specific procedure performed and the patient’s overall health status.

Are there different types of neovascular glaucoma?

Yes, there are two main types of neovascular glaucoma: primary and secondary. Primary neovascular glaucoma is less common and tends to occur without an identifiable cause. Secondary neovascular glaucoma is typically due to underlying conditions such as diabetes or hypertension.

Who are the best doctors for treating neovascular glaucoma in India?

India has some of the world’s best ophthalmologists who specialise in treating glaucoma. However, the best doctor for you would be one who understands your specific condition and requirements, and whom you feel comfortable with.

What is the success rate of neovascular glaucoma surgery?

The success rate of neovascular glaucoma surgery varies based on several factors, including the type of procedure performed, the severity of the disease, the patient’s overall health, and whether or not the patient strictly follows the post-operative care instructions. Your doctor can provide a more accurate prognosis based on your individual case.

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