Predictors of anterior chamber angle status at the time of neovascular glaucoma diagnosis

To identify clinical features which may predict the angle status of a large cohort of NVG eyes at the time of diagnosis. Chart review was performed for all NVG eyes from 2010 to 2022. Complete angle closure was defined as having >75 % PAS, partial angle closure as having 1–75 % PAS, and open angles as having 0 % PAS. Among 190 eyes (174 patients) with a diagnosis of NVG, 29 eyes (28 patients) had a prior NVG diagnosis and 32 eyes (31 patients) did not undergo gonioscopy; 129 eyes (115 patients, mean 65.5 years, 50 % women) had a gonioscopy documented at the time of diagnosis. There were 32 eyes (25 %) with open angles, 39 eyes (30 %) with partially closed angles, and 58 eyes (45 %) with completely closed angles. Mean BCVAs were 20/138 (logMar 0.84, CI = 0.78–0.90), 20/662 (logMar 1.52, CI = 1.41–1.62), and 20/4375 (logMar 2.34, CI = 2.17–2.51), respectively (p < 0.05). The mean presenting IOP was 31 mmHg, 40 mmHg, and 59 mmHg, and the proportion of eyes that were phakic were 47 %, 46 %, and 67 %, respectively. The proportion of eyes presenting to the emergency room were 6 %, 21 %, and 26 %, respectively. Among NVG eyes with a documented initial gonioscopy, nearly half had total synechial closure. While eyes with increasing degrees of angle closure trended towards worse vision and higher IOP, these clinical characteristics are not perfectly predictive of angle anatomy and should not replace gonioscopy. Eyes with closed angles trended towards being phakic, presenting to the emergency department (ED), having undergone prior panretinal photocoagulation (PRP), and belonging to new patients.