Neurovascular transluminal modulation in a pseudophakic glaucoma patient. A novel approach to glaucoma pathogenesis and treatment

Session Details

Session Title: Glaucoma II

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 08:18

Venue: Hall C4

First Author: : E.Patsoura GREECE

Co Author(s): :    S. Georgaras   N. Tsamopoulos                 

Abstract Details

Purpose:

To propose a new model of optic nerve damage in glaucoma, the model of Venous Neurovascular pathway to neuroinflammation, based on the theory that glaucoma is a neurodegenerative disorder and optic nerve is amenable to damage imposed by factors affecting the Central Nervous System

Setting:

Mediteranneo hospital , Athens , Greece Ophthalmos , Research & Therapeutic Institute, Athens , Greece

Methods:

Case report of a 73 yo pseudophakic female with chronic open angle glaucoma. Her right eye was relatively stable while the left sustained a deterioration of IOP control that required Express mini shunt insertion. In view of deteriorating visual field the patient was offered to be submitted to venous Doppler sonography that could elicit a cerebral circulatory abnormality with impact on ocular venous and lymphatic drainage. Percutaneous venous transluminal angioplasty was recommended based on diagnosis of chronic cerebrovascular venous insufficiency. Visual fields were examined before and 1, 6 and 12 months post surgery. Sonography was repeated 1 year post surgery.

Results:

The angioplasty procedure was successful. There was no intra or postoperative early or late complications. The visual field of the right eye had a clear improvement of about 1dB over the year that applies both for the MD and the PSD parameters. In the left eye the course of the visual field is more difficult to assess in view of the spikes and variation of IOP that eventually required glaucoma surgery. Patient also admitted some subjective improvement. There was no effect on IOP level or visual acuity post vascular surgery

Conclusions:

PVTA seems to positively influence visual fields in a controlled glaucomatous pseudophakic eye improving all parameters. The result is encouraging and brings promise of a safe and effective adjunctive therapy in glaucomatous patients with controlled IOP and either stable or progressing VF. However randomized controlled trials will be needed to provide true efficacy and safety data in order to become a more high level evidence based guideline recommendation

Financial Disclosure:

NONE