J Korean Ophthalmol Soc.  2012 Sep;53(9):1346-1351. 10.3341/jkos.2012.53.9.1346.

Neovascular Glaucoma with Ocular Ischemia in Superior Vena Cava Syndrome

• Jeon JH
• Cho KJ
• Chang KC
• Chang MH

• KMID: 2216091
• DOI: http://doi.org/10.3341/jkos.2012.53.9.1346

Abstract

PURPOSE
To report a case of neovascular glaucoma (NVG) with ocular ischemia in superior vena cava syndrome (SVCS).
CASE SUMMARY
A 57-year old male who had been treated for small cell lung cancer (SCLC) visited our hospital because of SVCS-like symptoms and decreased visual acuity in the right eye. On the initial examination, best corrected visual acuity was 0.5, intraocular pressure (IOP) was 38 mm Hg and relative afferent papillary defect was positive in the right eye. Slit lamp examination showed mild dilatation and tortuosity of the episcleral vessels and ruobeosis iridis. Gonioscopic examination showed neovascularization of the opened angle. Fluorescein angiography showed delayed choroidal filling and nevascularization of the disc. The patient was diagnosed with NVG with ocular ischemia in SVCS and was treated with chemotherapy and steroid therapy. In addition, intravitreal bevacizumab and IOP lowering eyedrops were administered to the right eye. During follow-up, neovascularizations disappeared and IOP was well controlled.
CONCLUSIONS
NVG with ocular ischemia in SVCS should be considered as a possible cause of high IOP in SCLC patients.

Keyword

Neovascular glaucoma; Superior vena cava syndrome

MeSH Terms

Antibodies, Monoclonal, Humanized
Choroid
Dilatation
Eye
Fluorescein Angiography
Follow-Up Studies
Glaucoma, Neovascular
Humans
Intraocular Pressure
Ischemia
Male
Ophthalmic Solutions
Small Cell Lung Carcinoma
Superior Vena Cava Syndrome
Vena Cava, Superior
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized
Ophthalmic Solutions

Figure

• 

  Figure 1 (A) Brain magnetic resonance imaging shows multiple metastasis of the small cell lung cancer. (B) The coronal view of chest computed tomography shows compression of the superior vena cava (lower arrow) and the right internal jugular vein (upper arrow) by lymphadenopathy and distention of the right internal jugular vein (upper arrow). The axial views of chest computed tomography show that (C) decreased diameter of the superior vena cava surrounded by lymphadenopathy and (D) diameter of the right common carotid artery (left arrow) near by lymphadenopathy was smaller than which of the left common carotid artery (right arrow).

• 

  Figure 2 Slit lamp and gonioscopic exam of right eye (A, B) and left eye (C, D). (A) Mild dilatation and tortuosity of the episcleral vessels of right eye (arrows). (B) Neovascularization of the angle (rectangle). (C) Mild dilatation and tortuosity of the episcleral vessels of left eye (arrows). (D) No specific finding of the angle.

• 

  Figure 3 Fundus photograph and fluorescein angiograph of right eye (A, B, C) and left eye (D, E, F). (A) Dot shaped hemorrhagies and neovascularization of the disc (NVD). (B) Fillings of the choroid and the retinal artery were started at 32 seconds after injection. (C) Filling of the temporal retinal vein was completed at 1 minute 11 seconds. Multiple microaneurysms and leaking around the disc. (D) Dot shaped hemorrhagies. (E) Venous phase shows multiple microaneurysms. (F) Late phase shows only multiple microaneurysms too.

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