Retinal Interventional Management of Blind Painful and Non-painful Eyes at Risk for Neovascular Glaucoma: Four Cases and Literature Review

• Main Authors: Salman Dar, Alana L. Grajewski, Elena Bitrian, Sandra R. Montezuma
• Format: Article
• Language: English
• Published: Pan-American Association of Ophthalmology 2015-09-01
• Series: Vision Pan-America
• Subjects: Blind painful eye, neovascular glaucoma, intracameral bevacizumab (ICB), endocyclophotocoagulation, panretinal photocoagulation, retrobulbar alcohol injections, enucleation, evisceration
• Online Access: http://journals.sfu.ca/paao/index.php/journal/article/view/264
• ISSN: 2219-4665; 2219-4673

Purpose: To review standard management of blind painful and non-painful eyes at risk for neovascular glaucoma, and report the management strategies of four cases. Method: Series of cases and literature review. Patients: The first two cases described are blind, painful eyes secondary to neovascular glaucoma, treated with intracameral bevacizumab injections. The third case, a blind, painful eye with uncontrolled glaucoma in a patient unsatisfied with her eye appearance due to white retained lens material at pupillary margin and a large prominent bleb, was treated with a combination of bleb revision, vitrectomy, lensectomy and endocyclophotocoagulation. The fourth case, a blind, non-painful eye with secondary radiation retinopathy at risk for neovascular glaucoma was treated with laser photocoagulation to prevent neovascular glaucoma and pain. Results: The first two cases of blind, painful eyes with neovascular glaucoma had reduction in neovascularization and pain after intracameral bevacizumab injections and/or laser therapy. The third case had resolution of pain and transient decrease in intraocular pressure after a combined surgery. The blind, non-painful eye in case 4 with a history of radiation retinopathy had stable intraocular pressure and no progression to neovascular glaucoma or pain. None of the four cases progressed to enucleation or evisceration. Discussion/Conclusion: Retinal interventional management should be considered in blind painful and non-painful eyes to help control symptoms, treat or prevent progression to neovascular glaucoma and prevention of enucleation or evisceration.