Neovascularization of angle following trabeculectomy augmented with mitomycin-C

Abstract

The purpose of this study was to report a case of neovascularization of angle (NVA) following trabeculectomy with mitomycin-c (MMC) in a patient with primary open-angle glaucoma. This case report describes a 68-year-old woman who developed NVA and hyphema 2 weeks following an uneventful trabeculectomy with MMC. Trabeculectomy may be associated with serious and vision-threatening complications such as hypotony, suprachoroidal hemorrhage, endophthalmitis, and bleb-related complications. However, neovascularization of the anterior segment is not a commonly reported complication. Neovascularization of the anterior segment is a rare postoperative complication that usually occurs following strabismus or retinal detachment surgeries. The underlying ischemic trigger for anterior segment neovascularization is usually a posterior segment pathology or carotid artery insufficiency. These causative factors were excluded in our patient by lack of any abnormal finding in fundus fluorescein angiography and carotid Doppler ultrasonography. The patient received three subconjunctival bevacizumab injections (1.25 mg/0.1 ml) with frequent topical steroids and showed marked regression of the neovessels. The bleb was functional, and intraocular pressure remained at low teen afterward. NVA following trabeculectomy without any posterior segment or carotid pathologies responded well to subconjunctival bevacizumab and topical steroids.

Anterior segment ischaemia following insertion of a PreserFlo Micro-Shunt with mitomycin-C for uncontrolled open angle glaucoma

“…No iris neovascularisation was detected. Treatment involved frequent use of topical steroids and weekly subconjunctival injection of bevacizumab for 3 weeks 15. The presentation, timeline of progression and final outcome in this case resemble our case reported here.…”

“…ASI has been reported only twice after glaucoma surgery in the last 30 years, both cases occurring after trabeculectomy surgery 14 15. To our knowledge, ours is the first reported case of ASI following PMS insertion in the literature.…”

Anterior segment ischaemia following insertion of a PreserFlo Micro-Shunt with mitomycin-C for uncontrolled open angle glaucoma

“…No iris neovascularisation was detected. Treatment involved frequent use of topical steroids and weekly subconjunctival injection of bevacizumab for 3 weeks 15. The presentation, timeline of progression and final outcome in this case resemble our case reported here.…”

“…ASI has been reported only twice after glaucoma surgery in the last 30 years, both cases occurring after trabeculectomy surgery 14 15. To our knowledge, ours is the first reported case of ASI following PMS insertion in the literature.…”

Iris neovascularization and neurotrophic keratopathy following ultrasound cycloplasty in refractory glaucoma: case series

“…Surgical procedures that damage the anterior ciliary arteries, which provide 70% of the anterior blood supply, are the main cause of ASI [ 12 ]. Strabismus surgery and circular buckling surgery can lead to ASI, and although it is less common, this complication can occur after uneventful anterior segment surgeries such as trabeculectomy and pterygium surgery [ 9 , 13 , 14 ]. Ciliary body ablation surgery, such as cyclocryotherapy and cyclophotocoagulation, which aim to destroy the function of pars plicata, carry a high risk of ASI [ 15 ].…”

Anterior segment ischaemia following insertion of a PreserFlo Micro-Shunt with mitomycin-C for uncontrolled open angle glaucoma

“…No iris neovascularisation was detected. Treatment involved frequent use of topical steroids and weekly subconjunctival injection of bevacizumab for 3 weeks 15. The presentation, timeline of progression and final outcome in this case resemble our case reported here.…”

“…ASI has been reported only twice after glaucoma surgery in the last 30 years, both cases occurring after trabeculectomy surgery 14 15. To our knowledge, ours is the first reported case of ASI following PMS insertion in the literature.…”

Iris neovascularization and neurotrophic keratopathy following ultrasound cycloplasty in refractory glaucoma: case series

“…Surgical procedures that damage the anterior ciliary arteries, which provide 70% of the anterior blood supply, are the main cause of ASI [ 12 ]. Strabismus surgery and circular buckling surgery can lead to ASI, and although it is less common, this complication can occur after uneventful anterior segment surgeries such as trabeculectomy and pterygium surgery [ 9 , 13 , 14 ]. Ciliary body ablation surgery, such as cyclocryotherapy and cyclophotocoagulation, which aim to destroy the function of pars plicata, carry a high risk of ASI [ 15 ].…”

Anterior segment ischaemia following insertion of a PreserFlo Micro-Shunt with mitomycin-C for uncontrolled open angle glaucoma

“…No iris neovascularisation was detected. Treatment involved frequent use of topical steroids and weekly subconjunctival injection of bevacizumab for 3 weeks 15. The presentation, timeline of progression and final outcome in this case resemble our case reported here.…”

“…ASI has been reported only twice after glaucoma surgery in the last 30 years, both cases occurring after trabeculectomy surgery 14 15. To our knowledge, ours is the first reported case of ASI following PMS insertion in the literature.…”

Iris neovascularization and neurotrophic keratopathy following ultrasound cycloplasty in refractory glaucoma: case series

“…Surgical procedures that damage the anterior ciliary arteries, which provide 70% of the anterior blood supply, are the main cause of ASI [ 12 ]. Strabismus surgery and circular buckling surgery can lead to ASI, and although it is less common, this complication can occur after uneventful anterior segment surgeries such as trabeculectomy and pterygium surgery [ 9 , 13 , 14 ]. Ciliary body ablation surgery, such as cyclocryotherapy and cyclophotocoagulation, which aim to destroy the function of pars plicata, carry a high risk of ASI [ 15 ].…”