Neovascular glaucoma as a first clinical manifestation of multiple sclerosis

To report a case with neovascular glaucoma caused by severe occlusive retinal vasculitis, as a first clinical manifestation of multiple sclerosis (MS).

Examination on an otherwise healthy 45-year-old man presenting with blurred vision in his right eye revealed bilateral iris neovascularization, right eye neovascular glaucoma, and bilateral retinal neovascularization caused by vasculitis. Thorough systemic investigation indicated by an ophthalmologist showed nothing else other than typical to MS imaging and spinal tap findings. The patient received bilateral treatment with panretinal photocoagulation and intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) injection in the right eye.

Ten months later, the patient was found with paraclinical neurologic findings completing the diagnostic criteria of definite laboratory supported MS. After the 3 years that followed, the ocular disease was eliminated, and the underlying disease remains clinically silent.

As illustrated by our case, MS should be considered as an underlying disorder in patients with neovascular glaucoma caused by occlusive retinal vasculitis.