Ocular Ischemic Syndrome and Neovascular Secondary Glaucoma

Abstract

Introduction. We present a case report of a 58-year-old man with bilateral carotid artery occlusion which caused ocular ischemic syndrome and neovascular secondary glaucoma. Case description. In 2012, a 58-year-old-man was diagnosed with primary open angle glaucoma. Due to decompensated intraocular pressure (IOP) despite maximal medical the rapy in 2014 laser trabeculoplasty on the patient’s left eye was performed. Later in 2014, the patient was diagnosed with an acute myocardial infarction complicated with hemorrhagic stroke. In March 2015, the patient was complaining of vision impairment lasting for 2 weeks. Visual acuity (VA) in the right eye decreased from 1.0 to 0.03 (decimal). Biomicroscopy revealed rubeosis iridis, retinal hemorrhages, retinal thinning, and ischemia probably due to an event of retinal artery occlusion. Further systemic evaluation revealed complete occlusion of the left internal carotid artery and critical stenosis (> 90 %) of the right internal carotid artery which resulted in successful stent implantation. In May 2015, due to decompensated IOP, low VA, laser cyclo destruction (LCD) was performed. In September 2015, the VA of the left eye started decreasing with development of rubeosis iridis, retinal peripherical hemorrhages which resulted in panretinal photocoagulation of the left eye. After a few LCD procedures and intravitreal as well as intracameral anti-VEGF injection in the left eye the IOP remained decompensated. After the Ahmed glaucoma valve implantation ,the IOP decreased for 9 months, but required the valve revision because of the response of the corneal endothelium. Summary. Ocular ischemic syndrome is a rare vision – threatening condition, which is caused by ocular hypo perfusion, due to stenosis or occlusion of the carotid arteries. Conclusions. Ocular ischemic syndrome is a dangerous disease and complications, such as neovascular glaucoma can cause irreversible visual loss and blindness. Both early diagnosis and aggressive treatment are necessary to prevent serious complications.