Combined endoscope-assisted procedures (CEaP) for the management of neovascular glaucoma

Neovascular glaucoma (NVG) is a severe and vision-threatening form of secondary glaucoma characterized by both retinal ischemia and elevated intraocular pressure (IOP). Effective management requires simultaneous control of the ischemic stimulus and IOP. However conventional cyclodestructive techniques are associated with significant risks including severe inflammation, hypotony and phthisis bulbi. This study aimed to evaluate the efficacy and safety of a combined surgical approach—endoscopic cyclophotocoagulation (ECP), pars plana vitrectomy (PPV), and panretinal photocoagulation (PRP)—for treating neovascular glaucoma (NVG). This retrospective, non-comparative interventional case series included 30 eyes from 30 patients treated at a tertiary referral care center in France. The primary outcome was mean intraocular pressure (IOP) reduction. Secondary outcomes included changes in best-corrected visual acuity (BCVA), pain levels, antiglaucoma medication use, and postoperative complications. The mean IOP decreased from 41.77 ± 9 mmHg preoperatively to 16.2 ± 8.1 mmHg at one month and 15 ± 9.35 mmHg at six months ( p < 0.0001). Pain levels and the number of antiglaucoma medications significantly decreased at 1 month ( p < 0.0001 and p = 0.00046, respectively). BCVA remained stable (2.26 to 2.37; p = 0.116), indicating preserved visual function. No intraoperative complications occurred. Early postoperative complications included transient corneal edema (13.3%), hyphema (16.7%), uveitis (20%), hypotony (6.7%), and others, all resolving without long-term sequelae. No severe adverse events were reported. This combined surgical technique appears safe and effective and may represent a promising early interventional strategy for NVG, significantly reducing IOP and treatment burden in a high-risk patient population.