J Korean Ophthalmol Soc.  2020 Mar;61(3):307-312. 10.3341/jkos.2020.61.3.307.

Regression of Neovascularization after Using Only Intraocular Pressure-lowering Medications in Neovascular Glaucoma

• Lee SW
• Kim KE

• KMID: 2471774
• DOI: http://doi.org/10.3341/jkos.2020.61.3.307

Abstract

PURPOSE
To report a case of neovascular glaucoma after intraocular lens iris fixation, in which the neovascularization of the iris and the anterior chamber improved with only intraocular pressure (IOP) lowering agents, without treatment of the underlying cause.
CASE SUMMARY
A 74-year-old woman who had undergone bilateral cataract surgery presented with left ocular pain and headache that started 3 days previously. At the initial examination, the best-corrected visual acuity was 0.9, and the IOP was 38 mmHg in the left eye. Slit-lamp examination of the left eye revealed diffuse iris neovascularization and several polypropylene suture knots fixated in the superior and inferior iris. Gonioscopic examination revealed angle neovascularization in all quadrants, with focal peripheral anterior synechia in the inferior quadrant. Fundus examination presented inferior neuroretinal rim thinning and an inferior retinal nerve fiber layer defect in the left eye. Fluorescent angiography showed no ischemic retinal lesions, with the exception of several retinal microaneurysms. Six months after topical IOP-lowering treatment in the left eye, the IOP was 10 mmHg, and neovascularization of the iris and angle had regressed completely.
CONCLUSIONS
In the case of early-stage neovascular glaucoma with partial angle closure not associated with retinal ischemia, IOP-lowering treatment can be effective without other invasive procedures.

Keyword

Angle neovascularization; Intraocular lens fixation; Intraocular pressure-lowering medication; Iris neovascularization; Neovascular glaucoma

MeSH Terms

Aged
Angiography
Anterior Chamber
Cataract
Female
Glaucoma, Neovascular*
Headache
Humans
Intraocular Pressure
Iris
Ischemia
Lenses, Intraocular
Nerve Fibers
Polypropylenes
Retinaldehyde
Sutures
Visual Acuity
Polypropylenes
Retinaldehyde

Figure

• 

  Figure 1 Initial anterior segment photographs of the left eye. (A) Slit-lamp examination showing diffuse iris neovascularization. (B) Note two polypropylene suture knots in the inferior part and (C) one in the superior part accompanying iris neovascularization (arrows). (D) Gonioscopic examination showing neovascularization (arrow) in all quadrants and the representative picture is shown in the temporal quadrant.

• 

  Figure 2 Initial examination of the patient. (A) Disc photograph showing an inferior neuroretinal rim thinning (arrow) and (B) red-free retinal nerve fiber layer (RNFL) photograph showing an inferior RNFL defect (arrowheads) in the left eye. Optical coherence tomography image presenting (C) inferior RNFL thinning and (D) corresponding retinal ganglion cell layer defect. (E) Fluorescein angiography image showing no definite ischemic retinal lesion, except several microaneurysms. NS = nasal-superior; TS = temporal-superior; T = temporal; TI = temporal-inferior; NI = nasal-inferior; G = global; N = nasal.

• 

  Figure 3 Anterior segment photographs of the left eye at six months after topical intraocular pressure lowering treatment. (A) Slit-lamp examination showing complete regression of the iris neovascularization. (B, C) The remaining polypropylene suture knots fixated in the iris with the compete regression of iris neovascularization. (D) Gonioscopic examination also showing complete regression of angle neovascularization.

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