Dr.GARIYASHEE LAHKAR

Dr.Jawahar Jyoti Kuli, Dr.Utkarsh Rai, Dr. BIKRAM DAM

Abstract

Refractory NVG is a severe form of secondary glaucoma characterised by uncontrolled IOP despite medical & surgical management. A 49 y/F presented with pain and redness of L/E for 30 days. On ocular examination, R/E appeared normal while in L/E there was no perception of light, mid-dilated non-reactive pupil & IOP was 60 mmHg. OS slit lamp examination was S/O 3600 iris neovascularisation, ciliary congestion and corneal oedema. Gonioscopy revealed angle closure. Fundus examination showed pale optic disc, CDR=0.9:1, multiple dot blot haemorrhages S/O supero-temporal BRVO. FFA revealed blocked fluorescence & leakage from neovascularisation. The patient underwent trabeculectomy and PRP with no decrease in IOP. Ahmed Glaucoma valve implantation was then combined with anti-VEGF showing marked decrease in IOP and rapid resolution of iris neovascularisation. The advent of anti-VEGF with drainage device appear as a promising treatment strategy for refractory NVG.