Preliminary clinical analysis of neovascular glaucoma secondary to carotid artery disease

Abstract

Background: Neovascular glaucoma (NVG) is a rare but severe complication of hypoperfusion retinopathy. Our objective was to analyse the clinical features of NVG secondary to carotid artery atherosclerosis, moyamoya disease and Takayasu arteritis. Methods: Thirty-six cases (36 eyes) with hypoperfusion retinopathy associated with NVG were retrospectively analysed. Each patient had their visual acuity assessed and fundus examined by fundus fluorescein angiography, colour Doppler flow imaging, magnetic resonance angiography, digital subtraction angiography and other techniques. Results: Eyes belonging to 30 males and six females were analysed. There were 24 right eyes and 12 left eyes. The ages of these patients ranged 18 to 78 years and the mean age was 40 years. The visual acuities ranged from light perception to 0.8 (decimal notation). Posterior segment manifestations included mid-peripheral intraretinal haemorrhages and narrowed retinal arteries. All eyes were associated with either an ipsilateral common carotid artery obstruction or a severe bilateral obstruction of the internal carotid arteries. Conclusions:The characteristic clinical features are presented during the process of the disease. Degeneration of the ocular fundus was predominantly on one side. The retinal manifestations included mid-peripheral haemorrhages and dilated retinal veins. High intraocular pressure and excavation and atrophy of the optic disc were common. In the eyes that were examined, neovascularisation was observed in the iris and anterior chamber and various visual field defects were present.

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

“…In surgery-related NVG, surgical intervention can quickly restore circulation to the ischemic area of the globe, resulting in massive raise in aqueous production and subsequent intraocular hypertension. In addition, the preexisting new vessels in the anterior chamber angle may cause additional obstruction of the meshwork, thereby more prone to develop NVG (59,81). These patients may sometimes present with normal or decreased IOP, due to chronic ischemia of the ciliary body (81).…”

“…In addition, the preexisting new vessels in the anterior chamber angle may cause additional obstruction of the meshwork, thereby more prone to develop NVG (59,81). These patients may sometimes present with normal or decreased IOP, due to chronic ischemia of the ciliary body (81). Patients should thus be carefully monitored for visual symptoms and IOP after the procedure to accurately diagnose and treat NVG.…”

Visual loss in Takayasu Arteritis – Look Beyond the Eye

“…Chronic visual loss in Takayasu arteritis may be due to Takayasu or hypertensive retinopathy [1,5], ocular ischemic syndrome [1], neovascular glaucoma [6], uveitis [7], cataract [1] and sclerokeratitis [8]. Treatment for Takayasu arteritis with disease modifying agents may also result in reduced vision due to complications such as steroid induced cataract, glaucoma and central serous retinopathy [1].…”

Germline Mutation of CBL Is Associated With Moyamoya Disease in a Child With Juvenile Myelomonocytic Leukemia and Noonan Syndrome‐Like Disorder

“…In brief, she already had moyamoya disease at the diagnosis of JMML, her neurological event recurred after failure of the first transplant, and no further progression has been observed over 4 years following the successful second transplant. Although she developed neovascular glaucoma 12 months after the second transplant, it was thought to occur secondary to retinal ischemia due to pre‐existing carotid artery stenosis . Thus, allogeneic hematopoietic stem cell transplantation (HSCT) might correct the pathophysiology of moyamoya disease.…”