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Abstract
Purpose
To report a case of neovascular glaucoma secondary to ocular ischemic syndrome in a patient with moyamoya disease, who was successfully treated with trabeculectomy.
Case summary
A 45-year-old woman suffered from slowly decreased vision in the right eye 3 months previously. Ocular pain with conjunctival injection of the right eye and headache developed 2 months earlier. She was diagnosed with moyamoya disease and had an encephaloduroarteriosynangiosis at the neurosurgery. The patient complained of persistent conjunctival injection and decreased vision of the right eye after surgery. At the initial visit, best corrected visual acuity (BCVA) of the right eye was 0.1 and intraocular pressure (IOP) was 42 mm Hg. Slit lamp examination revealed neovascularization of the iris and gonioscopy showed a 360° peripheral anterior synechiae. Fluorescein angiography demonstrated prolonged arteriovenous transit time in the right eye. On the electroretinogram, the amplitude of both a and b waves decreased in the right eye more than in the left eye. On the magnetic resonance angiography, narrowing of the right internal carotid artery was observed. The patient was diagnosed with neovascular glaucoma due to ocular ischemic syndrome caused by moyamoya disease. Panretinal photocoaguration, intravitreal bevacizumab injection and trabeculectomy with mitomycin-C soaking was performed in the right eye. At 8 months after surgery, BCVA of the right eye was 0.1, IOP was 17 mm Hg without antiglaucoma medication and bleb was maintained in good condition.
Figures and Tables
Figure 1
Magnetic resonance angiogram (MRA). (A) Narrowing of right internal carotid artery (white arrow). (B) Collateral vessels on the base of brain (white arrow).
Figure 2
(A) Slit lamp photograph of the right eye shows neovascularization of the iris and dilated pupil of the right eye at the initial visit. (B) Visual field examination of the right eye reveals remaining of central and temporal islands. (C) Color fundus photograph shows dot retinal hemorrhages at the mid-periphery of the retina, narrowed retinal artery, and dilated retinal vein. Vertical cup-disc ratio was 0.9. (D) Red-free fundus photograph shows superior and inferior retinal nerve fiber layer defects.
Figure 3
Fluorescent angiograph of the right eye. Choroidal filling is delayed, patchy choroidal filling is shown and leading edge of dye is seen. Arteriovenous transit time is delayed to about 50 second and venous filling time is about 58 second. Retinal capillary nonperfusion and microaneurysms are found. On the late stage, there are staining of the vessels, especially on the artery and arteriole.
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