Uncontrolled neovascular glaucoma – an alarming manifestation of chronic myeloid leukemia on imatinib therapy – a case report and review of literature

Abstract

A 45-year-old diabetic male, with diabetic retinopathy and medically uncontrolled neovascular glaucoma (NVG) underwent intracameral bevacizumab followed by trabeculectomy, with controlled intraocular pressures (IOP) post-operatively, OD: 12 mmHg; OS: 14 mmHg. Patient was referred to hematology, where he was diagnosed as chronic myeloid leukemia (CML) and started on imatinib mesylate. Thereafter, he presented with recurrence of neovascularization and vascularization of the bleb along with OS vitreous hemorrhage at 6 weeks follow-up. While he was planned for OS vitreo-retinal surgery, he presented with OD spontaneous hyphema with raised IOP (OD: 38 mmHg, OS: 16 mmHg). He had maintained a tight glycemic control. Following imatinib therapy, there was a rapid progression and recurrence of neovascularization, eventually leading to failure of trabeculectomy OD and bilateral severe loss of vision. Imatinib may be implicated in the worsening of NVG in CML patients, especially with co-existing diabetes and thus, such patients should receive regular thorough ophthalmic evaluation as long as imatinib continues.

Prognostic Evaluation of Vitrectomy Assisted by Lucentis in Diabetic Retinopathy and Neovascular Glaucoma

“…As such, a massive wide variety of new blood vessels are formed in the iris, chamber angle, and trabecular meshwork, which causes obstruction of the trabecular meshwork and the progressive closure of the chamber angle, thus preventing the normal out ow of aqueous humor, increasing intraocular pressure (IPO), and causing severe eye pain [3][4][5]. With the continuous increase of IOP, ocular ischemia and hypoxia cannot be controlled, contributing to optic nerve damage and visual impairment, which not only brings enormous damage to patients' bodies and minds but also greatly reduces their quality of life [6]. NVG has become a very common refractory glaucoma due to its severe clinical symptoms, great harm to the visual function of patients, and high blindness rate [7].…”

Vitreous hemorrhage: A rare ophthalmic adverse effect due to imatinib treatment

“…In the sixth week of imatinib treatment, the patient presented with a recurrence of neovascularization and vitreous hemorrhage. 13 In that case, the vitreous hemorrhage developed in a shorter time than in the current patient. This may be because the diabetes mellitus disease of that case contributed to the development of vitreous hemorrhage.…”