Treatment of neovascular glaucoma by Anti VEGF injections and laser

Since the 90s, most of the choroidal melanomas have been treated by radiotherapy either with brachytherapy or external beam.Unfortunately, post radiation complications may occur and neovascular glaucoma (GNV) is one the most feared. GNV happens in almost 23% of the cases at 5 years after irradiation, mostly for large melanomas but also for small ones. It complicates radiation retinopathy and toxic tumoral syndrome. As for diabetic retinopathy, laser photocoagulation can prevent the iris neovascularisation and glaucoma. If high pressure and secondary corneal edema are present, several authors have shown that intra‐vitreal or intra cameral injections of anti‐VEGF make iris neovessels regress and help the control of intra ocular pressure. In case of toxic tumoral syndrome, laser is ineffective and enucleation has often been necessary for intolerable pain. There is no recognized treatment for toxic tumoral syndrome: anti VEGF agents have shown good results for some patients but recent publications suggest that corticoid injections and surgical treatments may more efficient. GNV is a frequent and feared complication of ocular irradiation and its management requires several tools including laser and anti VEGF agents.