Neo-vascular glaucoma: etiology and outcome of treatment in Lagos

Abstract

Objective: To determine the causes and the intraocular pressure (IOP) outcome of neo-vascular glaucoma at the Guinness Eye Centre of the Lagos University Teaching Hospital, Lagos, Nigeria.

Materials and Methods: The case records of all patients with the diagnosis of neo-vascular glaucoma who presented at Guinness Eye Centre from January 1^st, 2008 to December 31^st, 2012 were reviewed. Information extracted from their records included the bio-data, eye affected, best corrected visual acuity, intra-ocular pressure, etiology of neo-vascular glaucoma, ocular co-morbidity, systemic co-morbidity and forms of treatment received. Cases of retinoblastoma were excluded from the study. Data were analyzed using the SPSS V.17.1

Results: A total of 31 cases of neovsacular glaucoma were reviewed. The male to female ratio was 1.8:1 and the age range was from 26 to 83 years. Patients aged 51 years or older were 22 (70.4%). The presenting best corrected visual acuity in the affected eye or in the worse affected eye was counting fi ngers in 30 (96%) patients. The presenting IOP was 30 mmHg or higher in 26 (83.2%). Both eyes were affected in three (9.6%) patients. Patients with diabetes mellitus, hypertension or both constituted 57.8% of the total number of patients. Primary open angle glaucoma and retina vein occlusion were the etiologies of neo-vascular glaucoma in 14 (45.2%) patients. A total of 15 (48.4) patients failed to turn up for repeat appointments. Only 5 (16.0%) patients (who received ocular medications, intravitreal bevacizumab and pan-retina photocoagulation) showed a significant IOP reduction.

Conclusion: Late presentation, loss to follow up and lack of full and complete treatment regime were important findings in this study. A significant IOP reduction occurred with only in the patients who had a combination therapy of IOP lowering medications, intravitreal bevacizumab and pan-retina photocoagulation. A routine eye examination for patients at risk is essential for early detection and treatment in order to minimize visual loss in neo-vascular glaucoma.

Keywords: Combination therapy, early detection, late presentation, neo-vascular glaucoma