Peripheral Anterior Synechiae Represent Progression Toward Neovascular Glaucoma

Among patients who developed NVG, median baseline visual acuity was logMAR 1.3 and declined to hand movements (logMAR 2.3). Conversely, the PDR-only cohort had a baseline median VA of 0.3 logMAR and fell to 2.7. This indicates a relatively universal poor prognosis for NVG but also suggests eyes with non-diabetic ASNV may have worse vision at presentation due to more severe retinal ischemia. Photo: Amila Herbert, OD. Click image to enlarge. Proliferative diabetic retinopathy (PDR) is a concern for patients with diabetes, as it can result in permanent and severe vision loss. While neovascularization as a result of this primarily affects the retina, it can also involve the anterior segment and includes neovascularization of the iris (NVI) and the angle (NVA).Outcomes of those affected in this way remains unclear in the literature, prompting researchers to investigate this in a recent study published in Eye. The study authors specifically looked at visual and intraocular pressure outcomes in those with anterior segment neovascularization due to PDR retinopathy and also assessed rates of neovascular glaucoma (NVG) development.A total of 116 eyes of 72 patients were included; eyes were then divided into three groups: NVI only, NVI and/or NVA without peripheral anterior synechiae (PAS) or eyes with PAS. It was found that both visual outcomes and intraocular pressure control were worse in eyes which had synechiae. Final median logMAR visual acuity was 0.36 for NVI, 0.44 in the NVI/NVA group and 2.30 for PAS, with vision loss of ≥3 lines in 34%, 31% and 71% of eyes in each respective group, respectively. A final visual acuity logMAR of ≥1.0 was seen in 71% of PAS eyes, while this was a much lower 18.2% in the other two groups. Neovascular glaucoma developed in 7.8% of eyes overall but in 53% of the PAS subgroup. What’s more, 41% of eyes with PAS required glaucoma surgery.In their paper, the researchers relay that the link between PAS, NVG and poor outcomes is well understood clinically, arguing that “our results formally support what most clinicians already recognize: that synechial angle closure represents a pivotal event” in the progression of neovascularization towards neovascular glaucoma and “irreversible visual loss.”The investigators add that these associations underscore the importance of detecting and managing anterior seg neovascularization before synechia formation happens—this is a critical period of time when outcomes remain more favorable. They further elaborate that panretinal photocoagulation was frequently used alone in eyes with only NVI, while those who had angle involvement were more likely to receive anti-VEGF therapy as well as the photocoagulation, reflecting a more aggressive treatment approach.Finally, the authors add that one consideration based on these findings is a lack of concordance between iris and angle neovascularization. As they explain, NVA could be present without clinically visible NVI, and some cases may persist after NVI regression. Related to this, they extrapolate that “this underscores the essential role of gonioscopy in both initial assessment and longitudinal monitoring” of eyes with anterior segment neovascularization. “Clinical reliance on iris neovascularization alone may underestimate ongoing angle disease and NVG risk,” they suggested.Click here for the journal source. Fiddimore E, Al-Janabi A, Sundararajan RS, Gallagher K. Neovascular glaucoma incidence and visual outcomes in treated proliferative diabetic retinopathy with anterior segment neovascularization. Eye (Lond). November 4, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.