Neovascular glaucomas after central retinal artery occlusions

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Abstract

Purpose

Neoovascular glaucoma after acute central retinal artery occlusion (CRAO) is underestimated. It is a serious complication, that can be prevented.

Methods

This retrospective study included all consecutive cases treated in Caen University Hospital (France), between January 2010 and December 2012. We studied the incidence of neovascular glaucoma in this cohort, the delay of onset, and the degree of arterial repermeabilisation on flurescein angiography. Patients with pre-existing ocular neovascularisation or evidence of ocular ischemic syndrome were excluded. We reviewed the literature about the diagnostic, therapeutic and epidemiological aspects of neovascular glaucoma after CRAO.

Results

Among thirty one patients with acute central retinal artery occlusion, five developed neovascular glaucoma (16%). These five patients had poor revascularisation, that was not diagnosed by the fundus examination. The time interval between the occlusive event and the neovascular glaucoma ranges from 7 weeks to 7 months. Patients were all treated with topical antiglaucoma drops. A panretinal photocoagulation (PRP) was done in 4 cases, associated with intravitreal bevacizumab injection in 2 cases, and with a transscleral cyclophotocoagulation with diode laser in one case.

Conclusion

Neovascular glaucoma is the height of CRAO. To prevent it, a fluorescein angiography should be performed a few deay after each CRAO to evaluate the repermeabilisation. If it is not good, a PRP should be quickly started, associated with a close follow up.

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