Neovascular glaucoma is a vision- and eye-threatening disease that carries a poor prognosis. Understanding the cause of neovascular glaucoma with early diagnosis and treatment is important for a positive outcome. There are numerous surgical treatment options available, but to have the best outcome, deciding which surgical technique to use is important. Some patients are better candidates than others for the various surgical techniques. An early- or late-stage clinical presentation, as well as the other ocular conditions associated with neovascular glaucoma, will dictate the appropriate surgical plan. This article provides a step-by-step approach to surgically managing neovascular glaucoma and explains new surgical techniques to help with the best chance of a positive patient outcome.