When the ophthalmologist becomes a detective

Session Details

Session Title: Presented Poster Session: Glaucoma

Venue: Poster Village: Pod 2

First Author: : F.Dolz Güerri SPAIN

Co Author(s): :    O. Pujol Carreras   A. Herranz Cabarcos   I. Alarcon Valero   J. Armentia Perez de Mendiola   A. Matheu Fabra           

Abstract Details

Purpose:

To report a case of neovascular glaucoma in a healthy young male. To interrogate the patient in an exhaustive way was the key to discover the cause of the neovascular glaucoma.

Setting:

Department of Ophthalmology. Hospital de l’Esperança and Hospital del Mar – Parc de Salut Mar. Barcelona. Spain

Methods:

26-years-old male referred to our hospital with the diagnosis of right-eye (OR) acute glaucoma with an intraocular pressures (IOP) of 47 mmHg. He was treated with oral acetazolamide and topical hypotensive agent. His only past medical history was long-term blepharoptosis and blepharitis. Visual acuity in his OR was no light perception and 0.8 in his left eye (OS). IOP was 18/16 mmHg. Slit-lamp examination showed stromal edema in OR, mild-dilated nonreactive right-eye pupil and iridis rubeosis. Both eyes presented posterior subcapsular cataracts. OR fundus showed scattered intraretinal hemorrhages and a pallor disc with cup-to-disc ratio 1, in OS was 0.6.

Results:

Study was performed to rule out thrombophiles, carotid artery obstructive disease and myasthenia. He was treated with panretinal photocoagulation and cyclophotocoagulation to control IOP. After asking the patient on different occasions for treatments he was doing, he remembered that he had been using gentamicin dexamethasone eye drops in both eyes daily for the last 5 years.

Conclusions:

Neovascular glaucoma (NVG) is a devastating ocular disease that often results in loss of vision. The three more common predisposing conditions for NVG are diabetic retinopathy, ischemic central retinal vein occlusion and the ocular ischemic syndrome. The many potential causes for NVG share the common pathway of extensive capillary nonperfusion that results in retinal hypoxia. Our case report shows how high IOP due to the use of self-administrated gentamicin dexamethasone eye-drops has been able to induce retinal hypoxia and NVG in a healthy young male.

Financial Disclosure:

None