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Jeon, Cho, Chang, and Chang: Neovascular Glaucoma with Ocular Ischemia in Superior Vena Cava Syndrome
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(9): 1346-1351.

Published online: 17 September 2012

DOI: https://doi.org/10.3341/jkos.2012.53.9.1346

Neovascular Glaucoma with Ocular Ischemia in Superior Vena Cava Syndrome

Ji Hoon Jeon, MD1, Kyong Jin Cho, MD1, Ki Cheol Chang, MD, PhD2, Moo Hwan Chang, MD, PhD1

1Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea.

2Onnuri Eye Clinic, Jeonju, Korea.

Address reprint requests to Moo Hwan Chang, MD, PhD. Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea. Tel: 82-41-550-6497, Fax: 82-41-561-0137, changmh@dankook.ac.kr

Received 7 January 2012       Accepted 24 June 2012

Copyright © 2012 The Korean Ophthalmological Society

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.

Keywords: Neovascular glaucoma, Superior vena cava syndrome

Figures and Tables

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).
jkos-53-1346-g001
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.
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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.
jkos-53-1346-g003

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