Neovascular glaucoma at a tertiary Centre in Finland, 2008–2024: A retrospective cohort study

PURPOSE: Neovascular glaucoma (NVG) is a refractory secondary glaucoma, yet longitudinal outcome data remain limited. This study reports its aetiologies, treatments and outcomes. METHODS: Patients with NVG were identified through electronic medical record review. Inclusion required documented rubeosis of the iris and/or anterior chamber angle, an intraocular pressure (IOP) ≥25 mmHg, diagnosis during 2008-2024, and follow-up at Helsinki University Hospital. Baseline data and all follow-up visits were included. RESULTS: Of 919 patients identified, 626 met inclusion criteria, with a median follow-up of 24 months. The estimated NVG incidence was 2.2/100000/year. The most common aetiology was central retinal vein occlusion (CRVO; 45%), followed by diabetic retinopathy (DR; 14%), central retinal artery occlusion (CRAO; 11%) and ocular ischaemic syndrome (8%). Half of the patients had hand motion vision or worse at baseline, with 18% at no light perception (NLP). At 5 years, 14% had decimal 0.1 vision or better. Visual outcomes differed by aetiology, with median time to NLP ranging from 1.6 (CRAO) to 9.1 (DR) years (log-rank p = 0.002). Median baseline IOP was 40 mmHg, decreasing to 20 mmHg by 1 year. Ocular pain fell from 43% at baseline to 11% at last follow-up. Structural eye loss (e.g. enucleation or phthisis) occurred in 3% by 5 years. CONCLUSION: The estimated NVG incidence was lower than previously reported elsewhere. Unlike other cohorts where DR predominates, CRVO was the most common aetiology and visual prognosis was strongly aetiology-dependent. Glaucoma drainage device surgery reached 8% at 3 years, despite the severity and refractory nature of NVG.