Topical and oral medical therapies are the initial treatment of choice to lower intraocular pressure (IOP) and limit vision loss and pain secondary to neovascular glaucoma (NVG). Therapies aimed at decreasing aqueous production (beta-blockers, topical and systemic carbonic anhydrase inhibitors, and alpha adrenergics) have the soundest rationale for use in NVG. No study is available in the literature comparing effectiveness of these various medications in NVG, and they are often required in combination. If the IOP is markedly elevated, it would not be inappropriate to commence simultaneously with an alpha-agonist, topical nonselective beta blocker, and topical carbonic anhydrase inhibitor.
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