Analysis of the Surgical Treatment of Neovascular Glaucoma: A Systematic Review

Abstract

This study aimed to conduct a systematic review of the literature on the main surgical modalities used in the treatment of neovascular glaucoma (NVG), emphasizing their temporal evolution, failure rates, and therapeutic indications according to etiology. The research was conducted between January and June 2025, with searches in PubMed, Scopus, Web of Science, Scielo, CAPES Journals, Google Scholar, and BIREME. Following rigorous screening based on predefined inclusion and exclusion criteria, 30 studies were selected. Their data were extracted, including information on the type of intervention (trabeculectomy, drainage implants, or cyclophotocoagulation); clinical outcomes; underlying etiology; and specific surgical recommendations. This revealed that drainage implants, particularly the Ahmed valve, demonstrated the lowest long-term failure rate. Trabeculectomy, although effective in early stages and in patients with no history of previous surgery, presented a higher risk of failure when associated with intense neovascularization. Meanwhile, slow-coagulation transscleral cyclophotocoagulation has emerged as a contemporary and effective alternative in eyes with compromised visual potential or refractory cases, supported by recent evidence of safety and efficacy. Furthermore, regarding indications by etiology, it was identified that in cases of proliferative diabetic retinopathy and venous occlusion, drainage implants were widely preferred, while trabeculectomy was performed in scenarios with minimal ocular inflammation and a still partially open angle. Therefore, the choice of surgical treatment for NVG should be individualized, considering the stage of the disease; underlying etiology; present inflammation; The ocular history and data analysis showed that valve implants remain the primary recommendation in advanced cases, while cyclophotocoagulation has established itself as a safe and effective option in refractory eyes. Trabeculectomy maintains its role, provided it is carefully indicated. Therefore, this review, while meeting the proposed objectives by synthesizing current practices, comparing the main surgical outcomes, and elucidating the best therapeutic indications according to recent scientific literature, still requires further research in this field to determine increasingly effective and safer protocols with fewer long-term adverse effects for the treatment of NVG.