Glaucoma neovascular

Other forms of glaucoma There is limited experience with latanoprost in the treatment of angle closure, inflammatory or neovascular glaucoma. 

Neovascular glaucoma is a condition maiked by new blood vessel proliferation on the iris and in the anterior chamber angle usually as a result of retinal or anterior segment ischemia/hypoxia. Neovascularization of the iris usually appears first on the surfece of the iris adjacent to the pupillary border.These vessels are fine in caliber and may have aneurysm-like outpouchings. Gonioscopic evaluation may reveal vessels in the anterior chamber angle even in the absence of iris vessels. 

In most cases the treatment of these conditions involves both anti-inflammatory (typically topical corticosteroids) and antiglaucoma (typically aqueous suppressants) medications. Cycloplegics are used to prevent or manage posterior synechia, secondary neovascular glaucoma, and choroidal effusion. Miotics are typically avoided in the management of these conditions because their use... 

Wand M, Dueker DK, Aiello LM, Grant WM. Effects of panretinal photocoagulation on rubeosis iridis, angle neovascularization, and neovascular glaucoma. Am J Ophthalmol 1978 86 332-339. 

Browning and Antoszyk (75) created an anastomosis in only two of eight eyes. These two eyes did not have improved visual acuity while two others without successful anastomosis did have improved visual acuity. Two of the eight patients developed tractional retinal detachment, three developed iris neovascularization, and one developed neovascular glaucoma. 

Kubota T, Tawara A, Khalil A, Honda M, Inomata H. Distribution of proteoglycans in the trabecular tissue of eyes with neovascular glaucoma. Ger J Ophthalmol 1996 5 392-398. 

Wakabayashi T, Oshima Y, Sakaguchi H, Ikuno Y, Miki A, Gomi F, Otori Y, Kamei M, Kusaka S, Tano Y. Intravitreal bevacizumab to treat iris neovascularization and neovascular glaucoma secondary to ischemic retinal diseases in 41 consecutive cases. Ophthalmology 2008 115(9) 1571-1580.el573. 

A hyperosmolar non-ketotic coma developed in a 29-year-oId diabetic patient with chronic renal failure after repeated oral use of 120 ml 50% glycerol solution, given every 12 hours for a neovascular glaucoma, in addition to 250 mg Diamox per os every 6 hours for 24 hours. Hyperosmolar non-ketotic coma is a serious disorder having a mortality rate between 20 and 70%. By applying i.v. hypotonic saline, albumin, packed red blood cells together with insulin and bicarbonate, the coma could be treated successfully (47 ). 

Presence of cataract Patients younger than 40 years of age Neovascular and uveitic glaucoma History of retinal detachment Asthma or history of asthma Phakic eyes°... 

Pilocarpine therapy should be avoided in certain patients (Box 10-10).This drug is contraindicated in patients with cataract, especially nuclear sclerotic and posterior subcapsular cataract, because the drug can affect vision and may accelerate the formation of lens opacities. Pilocarpine is generally contraindicated in patients younger than 40 years of age because of the intolerable accommodative spasm and refractive changes. Because breakdown of the blood-aqueous barrier occurs with the use of pilocarpine and other miotics, particularly in the presence of neovascular and uveitic glaucoma, pilocarpine should be avoided in these patients. 

Because intermediate uveitis does not involve the ciliary body or trabecular meshwork, lOP is rarely impacted by this disease course. However, should late-stage changes occur in the anterior chamber (e.g., synechiae, iris neovascularization), the clinician is obligated to perform tonometry and monitor for secondary glaucoma. Also, use of topical, injectable, and/or systemic corticosteroids in the treatment of uveitis may induce a precipitous rise in lOP, resulting in steroid-induced glaucoma. 

The primary vision-threatening manifestations of sarcoidosis are uveitis, glaucoma, and optic nerve involvement dry eye (keratoconjunctivitis sicca) is common but of lower risk. Anterior segment findings (including conjunctival granulomas, iris nodules, iridocyclitis, and keratoconjunctivitis sicca) occur in up to 70% of patients. In contrast, posterior uveitis occurs in up to 30% of patients. If only vasculitis, periphlebitis, or retinal neovascularization is considered, the frequency ranges from 4% to 17% of cases. Optic nerve involvement presents in up to 7% of patients. 

Unlikely Umbal infiltrates, corneal neovascularization, keratoconus, activation of herpes simplex, exophthalmos, pupil abnormalities, vitreous disturbance, glaucoma. 

The angle of the eye is examined by gonioscopy, which requires the use of special lenses. Gonioscopy is performed to rule out angle-closure or secondary causes of lOP elevation, such as angle recession, pigmentary glaucoma, and exfoliation syndrome. The peripheral contour of the iris is examined for plateau iris, and the trabecular meshwork for peripheral anterior synechiae, as well as for neovascular or inflammatory membranes. 

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