Neovascular glaucoma and carotid artery obstructive disease

Area of Science:

• Ophthalmology
• Vascular Surgery

Background:

• Carotid artery obstructive disease is an uncommon cause of neovascular glaucoma.
• This condition can present with atypical intraocular pressure (IOP) readings, including normotension or hypotension, due to reduced ciliary body perfusion.

Observation:

• Patients may exhibit normotensive or hypotensive intraocular pressure despite neovascular glaucoma.
• Fluorescein angiography can reveal delayed arm-to-retina circulation time and retinal arteriolar leakage.
• Anterior segment neovascularization may persist after panretinal photocoagulation due to ischemia.

Findings:

• Two patients with diabetes and hypertension presented with neovascular glaucoma secondary to carotid artery disease.
• Endarterectomy normalized intraocular pressure by restoring ciliary body perfusion.
• Cyclocryotherapy effectively reduced intraocular pressure and regressed rubeosis iridis in these cases.

Implications:

• Recognizing carotid artery disease in neovascular glaucoma is crucial for appropriate management.
• Surgical intervention for carotid obstruction can significantly impact intraocular pressure.
• Combined therapeutic approaches may be necessary for managing complex neovascular glaucoma cases.