Korean J Ophthalmol.  2013 Feb;27(1):64-67. 10.3341/kjo.2013.27.1.64.

Neovascular Glaucoma Due to Branch Retinal Vein Occlusion Combined with Branch Retinal Artery Occlusion

• An TS
• Kwon SI

• KMID: 1501801
• DOI: http://doi.org/10.3341/kjo.2013.27.1.64

Abstract

Branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO) rarely cause neovascular glaucoma (NVG). A 58-year-old woman with hypertension and type 2 diabetic mellitus complained of progressive visual loss in her right eye for the previous 3 months. At initial examination, visual acuity was 20 / 63 in the right eye. Angle neovascularization was observed and the intraocular pressure (IOP) was 30 mmHg in her right eye. Fundus examination and fluorescein angiography showed BRAO combined with BRVO. We immediately injected intravitreal and intracameral bevacizumab in her right eye. The next day, we performed scatter photocoagulation in the nonperfusion area. One month later, visual acuity was 20 / 20 in her right eye and the IOP was 17 mmHg with one topical antiglaucoma agent. The neovascularization had regressed completely. We report a case of unilateral NVG which was caused by BRAO with concomitant BRVO and advise close ophthalmic examination of the iris and angle in BRVO with BRAO.

Keyword

Branch retinal artery occlusion; Branch retinal vein occlusion; Neovascular glaucoma; Neovascularization; Retinal ischemia

MeSH Terms

Diagnosis, Differential
Female
Fluorescein Angiography
Fundus Oculi
Glaucoma, Neovascular/diagnosis/*etiology/physiopathology
Humans
Intraocular Pressure
Middle Aged
Retinal Artery Occlusion/*complications/diagnosis
Retinal Vein Occlusion/*complications/diagnosis

Figure

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  Fig. 1 Gonioscopic examination at initial examination showed 360 degree angle neovascularization (NVA) of the right eye. Arrows indicate NVA. (A) The gonioscopy revealed inferior NVA. (B) The gonioscopy revealed superior NVA. (C) The gonioscopy revealed nasal NVA. (D) The gonioscopy revealed temporal NVA.

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  Fig. 2 (A) In right eye, fundus examination showed scat tered retinal hemorrhage along the inferotemporal vein and ischemic edema in the inferior parafoveal area which was supplied by the small branches of the inferior retinal artery with atheroma at initial examination. (B) In left eye, fundus examination revealed a single peripapillary flame hemor rhage temporally and narrowing of the arterial vessels at initial examination.

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  Fig. 3 Fluorescein angiography (FA) at initial visit. (A) In right eye, FA of the right eye showed significant delayed filling of the branches of the inferior retinal artery in the ischemic area (30 seconds). (B) The foveal avascular zone was widened and the superior border was irregular with moderate leakage of dye from the arterioles (70 seconds). (C) A wide area of capillary nonperfusion in the distribution of the inferotemporal vein was also noticed, but choroidal perfu sion was normal in the right eye (10 minutes). (D) In left eye, arteriolar tortuosity and moderate leakage was found near the flame hemorrhage (70 seconds).

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