Effects of STA-MCA anastomosis for ischaemic oculopathy due to occlusion of the internal carotid artery

Summary Effects of STA-MCA anastomosis on two patients with neovascular glaucoma due to occlusion of the internal carotid artery are presented. Both patients improved in visual acuity and central retinal artery pressure as well as in signs of transient ischaemic attack. Postoperative angiography showed a marked decrease in collateral flow through the ophthalmic artery, which is reversed from the normal direction, with the development of blood flow through the anastomosis. Discussion is offered indicating that the lack of collateral flow through both the anterior and posterior communicating arteries is important in addition to occlusion of the internal carotid artery in order to produce full-blown ischaemic oculopathy such as venous stasis retinopathy, neovascular glaucoma or rubeosis iridis. It is stressed that EC-IC bypass surgery should be performed soon after the appearance of ischaemia and before the development of neovascular glaucoma or rubeosis iridis in order to obtain normal vision. In ischaemic oculopathy the results of EC-IC bypass can be evaluated objectively and quantitatively by many noninvasive neuro-ophthalmological tests which are important in discussing the efficacy of the bypass surgery.     

Presentation,etiology and treatment outcome of neovascular glaucoma in Ekiti state,South Western Nigeria

BackgroundNeovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical locations.ObjectiveThe objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital.MethodA retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25.Results29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up.ConclusionNVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices.     

Growth factors in the aqueous humor and their therapeutic implications in glaucoma and anterior segment disorders of the human eye

The presence of growth-promoting substances in the aqueous humor has been suspected for the past decade, but it has been only during the last 2 years that the existence of growth factors such as basic fibroblast growth factor, epidermal growth factor, transforming growth factorp, transferrin, and insulin-like growth factors in the aqueous humor has been demonstrated. The structures that border the anterior and posterior chambers of the eye syn- thesize some of these growth factors and release them into the aqueous humor. A breakdown of the blood-aqueous-barrier increases the amounts of growth factors and may also bring platelet-derived growth factor, nerve growth factor, and interleukin-6 into the aqueous humor. Growth factors maintain the normal function of ocular tissues in health and have a significant role in the pathogenesis and possible management of several disorders of the eye. The outcome of the pathogenetic process and its modulation are determined by a complex coordination and interactions of the growth factors in the aqueous humor and their eventual effect on the target tissues. We discuss the therapeutic implications of growth factors and their antagonists in the treatment of certain disorders of the anterior segment of the eye, including rubeosis iridis, neovascular glaucoma, primary open-angle glaucoma, sand wound after filtration Surgery.     

12例新生血管性青光眼的治疗

为探讨睫状体冷冻及前段视网膜冷凝术，。对治疗新生血管性青光眼提供有益经验，我们对１２例新生血管性青光眼进行睫状体冷冻及前段视网膜冷凝术，随访１到１２个月，随访检查：眼压，虹膜面新生血管等。结果显示：１２例患者中，１０例眼压降至正常范围，２例眼压仍高，术后一周内虹膜面新生血管明显减少甚至消失。     

Rubeosis iridis in "pseudogliomas"

A total of 85 eyes (75 patients) with pseudogliomas (i.e., certain conditions which simulate retinoblastoma, were examined histopathologically to determine the incidence of rubeosis iridis. Neovascularization of the anterior surface of the iris was found in 70 eyes (82%). The principal associated changes in these eyes were moderate to severe inflammation of the uveal tract and retinal detachment. These findings are interpreted as indicating that inflammation, retinal detachment, and/or ischemia are effective stimulants in producing iris neovascularization, and rubeosis is not a significant factor in differentiating eyes with retinoblastoma from those eyes with pseudogliomas.     

Heterochromia iridis and Homer's syndrome due to paravertebral neurilemmoma

A case of heterochromia iridis and Horner's syndrome is reported in a 7-year old girl with paravertebral neurilemmoma. These clinical findings can be useful in the early diagnosis of mediastinal tumors in the paravertebral axis. While typically associated with neuroblastoma, these findings can be due to tumors which are inately benign — in this case neurilemmoma. The mechanism for heterochromia is briefly discussed.     

Choroidal melanoma with massive retinal fibrosis and spontaneous regression of retinal detachment.

An unusual case of choroidal malignant melanoma with heterochromia iridis, massive subretinal hemorrhage and fibrosis, spontaneously resolving retinal detachment, and subretinal seeding is reported. Clinical and pathological findings are presented and discussed. The unusual aspects of the case are further considered by Drs. Andrew Ferry and Mark Tso.     

Bevacizumab (Avastin) for the treatment of neovascular glaucoma

Herein three cases of angle closure secondary to neovascularization (elevated intraocular pressure in two of the cases) treated with the anti-vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) are reported. In all three cases there was rapid resolution of neovascularization and control of intraocular pressure. One patient with corneal anaesthesia from diabetes developed infectious keratitis, potentially as a consequence of inhibition of VEGF wound healing and neurotrophic functions. Avastin appears to have a promising role in the treatment of neovascular glaucoma but is not without potential local and systemic side-effects.