Neovascular Glaucoma post Carotid Interventional Procedures (CAS and CEA)- A narrative review

Neovascular glaucoma following carotid revascularization procedures represents a rare but devastating complication that challenges conventional understanding of post-interventional outcomes. Despite the widespread utilization of carotid endarterectomy and endovascular interventions, this paradoxical visual deterioration following successful vascular reconstruction remains poorly understood and inadequately recognized. This narrative review synthesizes the existing literature to provide comprehensive analysis of the epidemiological patterns, pathophysiological mechanisms, clinical presentations, therapeutic approaches, and outcomes associated with post-revascularization neovascular glaucoma.A literature search was conducted across multiple databases including PubMed, Embase, Cochrane Library, and Google Scholar from inception through August 2025. Search terms encompassed neovascular glaucoma, carotid revascularization procedures, and related complications. Cases reporting post carotid-revascularization neovascular glaucoma were included, with data extracted for narrative synthesis. Work published in non-English language along with conference proceedings were excluded. Few cases have been documented worldwide, predominantly affecting elderly diabetic males with severe carotid stenosis. The temporal presentation demonstrates consistent patterns within a day to two weeks post-procedure, in both surgical endarterectomy and endovascular interventions. The pathophysiological framework centers upon chronic ocular ischemia creating aqueous humor production-resorption imbalance that becomes disrupted upon perfusion restoration. Clinical manifestations include severe intraocular pressure elevation rubeosis iridis, and rapid visual deterioration. Despite aggressive multimodal therapeutic intervention incorporating medical management and surgical procedures, visual outcomes remain uniformly poor with most patients experiencing severe visual impairment or complete blindness. Post-revascularization neovascular glaucoma represents an irreversible complication emphasizing prevention over treatment. Heightened clinical awareness, immediate ophthalmological consultation for post-procedural ocular symptoms, and development of evidence-based surveillance protocols represent critical priorities for optimizing outcomes in this vulnerable patient population.