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Abstract: Neovascular glaucoma is a common type of glaucoma, with iris neovascularization as the main manifestation. A 60-year-old male patient recently presented to our hospital with swelling and blurred vision in the left eye, accompanied by ipsilateral headache, and was diagnosed with this disease after examination. He was treated with medication to reduce swelling and intraocular pressure, and his condition was stabilized after trabeculectomy of the left eye.
Basic information】Male, 60 years old
Disease Type】Glaucoma (neovascular glaucoma)
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】January 2022
Treatment plan】Topical medication (brinzolamide eye drops, brimonidine tartrate eye drops, carteolol hydrochloride eye drops, tobramycin dexamethasone eye drops, levofloxacin eye drops) + intravenous infusion (mannitol injection) + surgical treatment (trabeculectomy of the left eye)
[Treatment period] Hospitalization for 1 week, review after 3 days
Treatment effect】Symptoms improved and the condition was stable
I. Initial consultation
The patient, male, 60 years old, presented 1 week ago with no obvious cause and trigger of left eye distension and blurred vision, accompanied by ipsilateral headache, nausea, no vomiting, no photophobia, lacrimation and other discomfort, self-administered erythromycin ophthalmic ointment treatment, the effect was not good, the symptoms gradually worsened, for further diagnosis and treatment, came to our hospital. Ophthalmologic examination, visual acuity: 4.7 in the right eye, several fingers in the left eye; intraocular pressure: 23 mmHg in the right eye, 80 mmHg in the left eye, no significant abnormalities in the right eye, mixed congestion in the left eye, corneal epithelial edema, deep in the anterior chamber, atrial aqueous unclear, pupil diameter of about 4 mm, sluggish response to light, the iris saw a large number of neovascularization, mild clouding of the crystal, internal blurring. The initial diagnosis was glaucoma (neovascular glaucoma), and he was admitted to the hospital for treatment.
II. Treatment history
The patient was examined by ophthalmologic examination: the pressure in the left eye was increased and the corneal epithelium was edematous, which made surgical treatment inappropriate. After communication with the patient, it was decided that symptomatic treatment should be given first before surgery. The patient was given brinzolamide eye drops, brimonidine tartrate eye drops and carteolol hydrochloride eye drops in combination with mannitol injection intravenously to lower the intraocular pressure and reduce the edema caused by high intraocular pressure. After the contraindication of surgery, trabeculectomy was performed in the left eye, and the patient was returned to the ward after surgery, and tobramycin dexamethasone eye drops and levofloxacin eye drops were used to reduce postoperative tissue edema and prevent the occurrence of infection. 1 week later, if the patient had no other uncomfortable symptoms, he could be discharged from the hospital.
III. Treatment effect
Before treatment, the patient had mixed congestion in the left eye, corneal epithelial edema, deep anterior chamber, and massive neovascularization in the iris. After 1 week of drug and surgical treatment, the left eye was free of distension and pain. Ophthalmologic examination showed visual acuity: 4.7 in the right eye and several fingers/eye in the left eye; intraocular pressure: 18 mmHlg in the right eye and 50 mmHg in the left eye, corneal transparency in the left eye, deep anterior chamber, periocular incision was open, iris pupillary margin pigment ectropion, and neovascularization subsided, and the rest was approximately the same as before. He was discharged from the hospital for convalescence and returned to the hospital for review in 3 days, with prompt medical attention in case of discomfort.
IV. Notes
The patient’s condition was stable after treatment, and I was happy for her. In order for the patient to have a good recovery, I did not forget to emphasize to the patient that the following points should be noted in life after treatment.
1, follow the doctor’s prescription for medication, 1 drop of eye drops each time is enough, should not point more, so as not to spill the liquid to cause waste.
2, it is advisable to eat vitamin-rich, low-fat food, eat more fish, vegetables, fruits, avoid overeating.
3.After the condition is stabilized, pay attention to reasonable use of eyes, avoid watching TV, cell phones, head down for a long time, so as not to increase eye pressure.
4. Develop good living habits, combine work and rest, and avoid excessive eye strain.
V. Personal insight
Glaucoma is an important cause of blindness in the elderly, and is related to the damage to the iris, cornea and lens caused by elevated intraocular pressure. Early detection and treatment can inhibit the progression of the disease and maintain the existing visual function. The typical manifestations of the disease are blurred vision, headache, and eye swelling, and once these symptoms appear, you should seek prompt medical attention and active treatment. For example, in this case, due to timely consultation, the prognosis is good after surgical treatment, and no serious adverse consequences were caused. In addition, patients should insist on regular follow-up after discharge from the hospital, and it is recommended to have an eye examination every six months to detect changes in the condition in a timely manner.