Title : A case of ‘60-day glaucoma’
Abstract:
Introduction: Neovascular glaucoma (NVG) has been called ‘90-’ or ‘100-day glaucoma’ in the past due to its typical development 3 months after the onset of central retinal vein occlusion (CRVO). In reality, NVG can occur anywhere between 2 weeks and 2 years after initial CRVO with over 80% occurring within 6 months.
Case Presentation: A 90-year-old female presented to eye casualty with painless loss of vision in the left eye, onset less than 12 hours. Right eye visual acuity (RVA) was 0.10 logMAR (6/7.5 snellen) and left eye visual acuity (LVA) was counting fingers (CF), previous LVA was 6/6. Fundus examination revealed left CRVO with normal bilateral intraocular pressures (IOP). Two months later the patient presented to the emergency department with an excruciatingly painful left eye. IOP was 10mmHg and 42mmHg in the right and left eye repectively. On examination of the left eye there was corneal oedema, shallow anterior chamber angle, hyphema, rubeosis iridis and a RAPD. LVA had dropped to hand movement and a diagnosis of left neovascular glaucoma secondary to ischaemic CRVO was made. Due to the hazy cornea PRP was unsuitable and so the patient was treated with topical IOP lowering agents, topical steroids and cyclopentolate. One month later the left IOP had come down to 27mmHg. The corneal oedema had slightly improved but LVA was now light perception. The patient no longer reported any ocular pain or discomfort and has been referred to a glaucoma specialist for consideration of left cyclodiode.
Conclusion: More than 90% of patients with ischaemic CRVO have a final visual acuity of 6/60 or worse. 30% of eyes with non-ischaemic CRVO may convert to an ischaemic CRVO over 3 years, with a 16% conversion rate within the first 4 months of the initial occlusion. This case highlights the importance of early detection of cases likely to convert to an ischaemic CRVO and the importance of regular follow up of these patients.
