Predictors of visual acuity, intraocular pressure and pain in neovascular glaucoma

PURPOSE: To identify factors associated with best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ocular pain in neovascular glaucoma (NVG). METHODS: The retrospective cohort included all patients diagnosed with NVG during 2008-2024 at Helsinki University Hospital, Finland. Linear mixed-effects models used pre-specified covariates, whereas exploratory machine-learning models used all longitudinal data, including biomicroscopic findings. RESULTS: The cohort comprised 626 patients (median follow-up 24 months). Follow-up BCVA was worse in eyes with worse baseline BCVA. A closed anterior chamber angle was associated with 0.13 logarithm of the minimum angle of resolution worse BCVA (95% confidence interval, CI, 0.02-0.23). Age, sex and comorbidity were largely not associated with the outcomes. Glaucoma drainage devices showed the greatest initial IOP reduction (-10.2 mmHg, 95% CI, -11.9 to -8.6), followed by transscleral cyclophotocoagulation (TSCPC, -4.7 mmHg, 95% CI, -5.8 to -3.7) and peripheral retinal cryotherapy (-2.2 mmHg, 95% CI, -3.1 to -1.4). TSCPC and cryotherapy were also associated with less pain (odds ratios 0.51 and 0.46, 95% CI, 0.36-0.74 and 0.34-0.63). Panretinal photocoagulation and anti-vascular endothelial growth factor injections showed smaller IOP reductions, with pain reduction for panretinal photocoagulation only. Machine learning added no findings beyond the mixed models. CONCLUSION: Treatments were associated with lower IOP and less pain but not with better BCVA, which baseline severity largely explained. Cryotherapy, seldom reported in NVG, showed comparable associations. IOP control and pain relief may therefore remain realistic goals when visual prognosis is poor. Confounding by indication remains possible.