2Associate Prof, MD, Gulhane Training and Research Hospital, Department of Ophthalmology, Ankara, Turkey DOI : 10.37844/glauc.cat.2020.15.42 Background: Medical and surgical management of one-eyed patient with neovascular glaucoma secondary to proliferative diabetic retinopathy, chronic myeloid leukemia and chronic renal failure.
Case report: A 68-year-old male patient with type 2 diabetes mellitus, chronic myeloid leukemia and chronic renal failure presented with sudden loss of vision in the right eye. In the left eye, there was visual acuity at the level of light perception and glaucomatous optic atrophy. In the right eye, the best-corrected visual acuity was 0.1 and anterior segment examination revealed rubeosis iridis and diffuse peripheral anterior synechia. In fundus examination, there were fi ndings of diabetic retinopathy with cup: disc ratio of 4:10, peripapillary splinter hemorrhage and intraocular pressure of 40 mmHg. Despite initiation the maximal medical anti-glaucomatous treatment, it was failed to reduce IOP. Optical medium did not allow panretinal laser photocoagulation. Anterior chamber (half dose) and intravitreal (full dose) anti-VEGF (afl ibercept) injections were performed. Following regression of rubeosis iridis, pars plana vitrectomy and panretinal endolaser photocoagulation were performed in combination with cataract surgery. Ahmed valve tube implantation was performed because the postoperative intraocular pressure was 28 mmHg. Intraocular pressure decreased to 10 mmHg. Here, we highlighted the points to be considered in the management of a one-eyed neovascular glaucoma case.
Conclusion: Intracameral and intravitreal anti-VEGF (afl ibercept) injection, panretinal laser photocoagulation, pars plana vitrectomy are effective and reliable treatments for regression of rubeosis iridis in patients with neovascular glaucoma. Also, in these patients, glaucoma drainage implants have an important role in the control of intraocular pressure and glaucoma management.
Keywords : Neovascular glaucoma, Rubeosis iridis, Afl ibercept, Ahmed glaucoma valve implantation