A review of neovascular glaucoma. Etiopathogenesis and treatment.

Object. The authors report their experience using gamma knife radiosurgery (GKS) to treat uveal melanomas. Methods. Between 1992 and 1998, 60 patients were treated with GKS at a prescription dose between 45 Gy and 80 Gy. The mean diameter of the tumor base was 12.2 mm (range 3–22 mm). The mean height of the tumor prominence was 6.7 mm (range 3–12 mm). The eye was immobilized. The follow-up period ranged from 16 to 94 months. Tumor regression was achieved in 56 (93%) of 60 patients. There were four recurrences followed by enucleation. The severe side effect of neovascular glaucoma developed in 21 (35%) patients in a high-dose group with larger tumors and in proximity to the ciliary body. A reduction in the prescription dose to 40 Gy or less and excluding treatment to tumors near the ciliary body decreased the rate of glaucoma without affecting the rate of tumor control. Conclusions. Gamma knife radiosurgery at a prescription dose of 45 Gy or more can achieve tumor regression in 85% of the uveal melanomas treated. Neovascular glaucoma can develop in patients when using this dose in tumors near the ciliary body. It is advised that such tumors be avoided and that the prescription dose be reduced to 40 Gy.

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Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05172-6 ◽

2021 ◽

Author(s):

Feng Gao ◽

Jiajian Wang ◽

Junyi Chen ◽

Xiaolei Wang ◽

Yuhong Chen ◽

...

Keyword(s):

Clinical Characteristics ◽

Anterior Segment ◽

Young Patients ◽

Case Series ◽

Neovascular Glaucoma ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Uncommon Presentation ◽

Underlying Causes

Abstract Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

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Postprocedural Endophthalmitis or Postprocedural Intraocular Inflammation: A Diagnostic Conundrum

Case Reports in Ophthalmology ◽

10.1159/000511970 ◽

2021 ◽

pp. 418-424

Author(s):

Aisha Al Busaidi ◽

Ahmed Al-Hinai

Keyword(s):

Pars Plana Vitrectomy ◽

Povidone Iodine ◽

Complete Recovery ◽

Neovascular Glaucoma ◽

Intraocular Inflammation ◽

Aqueous Samples ◽

Patient Counseling ◽

Pars Plana ◽

Culture Negative ◽

Office Procedures

We experienced an atypical endophthalmitis occurring post consecutively performed in-office procedures; an intravitreal injection (IVI) of ranibizumab followed by an anterior chamber (AC) paracentesis performed twice in an eye with neovascular glaucoma (NVG). A 52-year-old diabetic male who was asymptomatic developed signs of endophthalmitis and decreased vision without pain in his left eye a few days post-IVI and AC paracentesis. The condition worsened after an initial vitreous tap and injection of antibiotics. Cultures of vitreous and aqueous samples were negative. Complete resolution occurred after a pars plana vitrectomy with IVI of antibiotics and steroid with removal of a dense “yellowish-brown” fibrinous plaque. The absence of pain, presence of a peculiar colored fibrin, mild-to-moderate vitritis without retinitis, negative cultures, and complete recovery despite the fulminant presentation; favor a diagnosis of inflammation over infection. We hypothesize that a micro-leak from a 26-gauge AC tap tract might have served as an entry port for 5% povidone-iodine from the ocular surface thus inciting inflammation. However, an exuberant inflammatory response that can be typically seen in NVG eyes after intraocular procedures cannot be excluded. Various causes of inflammation post-procedures, both toxic and nontoxic should be considered in atypical culture-negative fulminant endophthalmitis cases with good outcome posttreatment. Any minor ocular procedure may carry a risk of such complication. Patient counseling and care must be exercised in performing these procedures.

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Various modalities for management of secondary angle closure neovascular glaucoma in diabetic eyes: 1-year comparative study

International Ophthalmology ◽

10.1007/s10792-020-01673-1 ◽

2021 ◽

Author(s):

Heba Magdy Ahmed El-Saied ◽

Mohamad Amr Salah Eddin Abdelhakim

Keyword(s):

Comparative Study ◽

Neovascular Glaucoma ◽

Angle Closure

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Bevacizumab as adjuvant for neovascular glaucoma

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2008.01355.x ◽

2010 ◽

Vol 88 (1) ◽

pp. 103-109 ◽

Cited By ~ 33

Author(s):

Julia Beutel ◽

Swaantje Peters ◽

Matthias Lüke ◽

Sabin Aisenbrey ◽

Peter Szurman ◽

...

Keyword(s):

Neovascular Glaucoma

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Rubeosis iridis and macular hemorrhages from multiple Corkscrew retinal vessels in a patient with NF1

European Journal of Ophthalmology ◽

10.1177/1120672121996636 ◽

2021 ◽

pp. 112067212199663

Author(s):

Marilyn A Márquez ◽

Claudio P Juárez ◽

Maria C Sánchez ◽

Jose D Luna

Keyword(s):

Intravitreal Bevacizumab ◽

Visual Outcome ◽

Neovascular Glaucoma ◽

Retinal Vessels ◽

Retinal Hemorrhages ◽

Fluorescein Angiogram ◽

Rubeosis Iridis ◽

Good Visual Outcome ◽

Av Malformation ◽

Sudden Decrease

Purpose: To report a case of a patient with NF1 presenting with ocular findings of AV malformation, multiple retinal hemorrhages, and neovascular glaucoma in the absence of retinal ischemia. Methods: Review of the medical record was conducted in accordance with the local IRBt. Results: A 60-year-old female patient with diagnosis of Neurofibromatosis type1 (NF1) and sudden decrease of vision in her left eye was found to have rubeosis iridis and high intraocular pressure (IOP). On fundus exam multiple corkscrew retinal vessels and retinal hemorrhages were present in her left eye. On Optical Coherence Tomography (OCT) the foveal hemorrhages appeared as outer layer hyperreflective retinal infiltrates whereas in the parafoveal area the hyperreflectivity was present between the RPE and neurosensory retina. Fluorescein Angiogram (FA) showed normal perfusion and no areas of leakage or ischemia. Treatment with anti-angiogenics in a timely manner correlated with a good visual outcome. Conclusions: We present a unique patient with NF1, rubeosis iridis, high IOP, and macular hemorrhages from multiple corkscrew retinal vessels in a well perfused retina, who underwent treatment with a single dose of intravitreal Bevacizumab and had an excellent response

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