Clinical Outcomes of Neovascular Glaucoma in Patients with Prior and Non-Prior Intravitreal Anti-VEGF Treatment: A Retrospective Cohort Study

Purpose: To compare 1-year clinical outcomes between patients with neovascular glaucoma (NVG) who received intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy prior to NVG diagnosis and those who did not. Patients and Methods: This retrospective cohort study included patients newly diagnosed with NVG at King Chulalongkorn Memorial Hospital, Thailand, who completed a 1-year follow-up. Participants were categorized into a prior anti-VEGF group and a non-prior anti-VEGF group. Ocular characteristics, including intraocular pressure (IOP) and number of anti-glaucoma medications, were recorded at baseline and at 1, 3, 6, and 12 months. Best-corrected visual acuity (BCVA) and pan-retinal photocoagulation (PRP) status were assessed at baseline and 12 months. The number of post-enrollment anti-VEGF injections, requirement for glaucoma surgery, and NVG recurrence were evaluated at 12 months. Results: Seventy-three eyes from 73 patients were analyzed (18 prior anti-VEGF; 55 non-prior anti-VEGF). Both groups demonstrated significant IOP reduction at all follow-up visits compared with baseline (P< 0.001), with no significant between-group differences at any time point (P=0.205– 0.898). Anti-glaucoma medications use significantly decreased in the non-prior anti-VEGF group starting from 3-month follow-up (P< 0.001), but not in the prior anti-VEGF group (P=0.082), with no significant between-group difference (P=0.586). The prior anti-VEGF group had a higher proportion of no light perception (P=0.047), although BCVA change did not differ significantly between groups (P=0.126). No significant between-group differences were observed in post-enrollment anti-VEGF injections, PRP status, glaucoma surgery, or NVG recurrence (P=0.504– 0.920). Baseline IOP was significantly associated with time to first glaucoma surgery (β= − 0.06, P=0.005). Conclusion: Although no significant differences in IOP reduction were observed between NVG patients with and without prior anti-VEGF treatment, both groups achieved significant IOP reduction following treatment initiation. Patients without prior anti-VEGF therapy demonstrated a greater reduction in medication burden at 1 year compared with those who had received prior anti-VEGF treatment.