Sora Daisuke, Takayama Kei, Taguchi Manzo, Sato Tomohito, Sakurai Yutaka, Kanda Takayuki, Takeuchi Masaru
Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan.
Case Rep Ophthalmol. 2018 Mar 28;9(1):243-247. doi: 10.1159/000488137. eCollection 2018 Jan-Apr.
We report a case of topical corticosteroid treatment-resolved rubeosis iridis with neovascular glaucoma (NVG) caused by noninfectious granulomatous uveitis.
A 61-year-old woman with left ocular pain and blurred vision was referred to our department. Visual acuity and intraocular pressure (IOP) were 20/60 and 37 mm Hg in the left eye, respectively. Inflammatory cells, hyphema, and rubeosis iridis were observed. All laboratory tests, including multiplex polymerase chain reaction for infection using aqueous humor, were negative, and there was neither retinal occlusive vasculitis nor retinal ischemia in the fundus. Our diagnosis was noninfectious granulomatous anterior uveitis-associated NVG. Topical corticosteroid treatment and anti-glaucoma agents resolved inflammation, rubeosis iridis, and NVG. IOP had decreased to 13 mm Hg by 1 month of treatment, and no recurrence was observed.
Topical corticosteroid could resolve rubeosis iridis and NVG in an eye with noninfectious anterior uveitis. The pathogenesis of NVG in eyes with uveitis is still unknown, but inflammation might have a part in angiogenesis. Anti-inflammatory treatment can be selected as the first choice for anterior uveitis-associated NVG.
我们报告一例由非感染性肉芽肿性葡萄膜炎引起的、经局部糖皮质激素治疗后缓解的虹膜红变合并新生血管性青光眼(NVG)病例。
一名61岁女性因左眼疼痛和视力模糊转诊至我科。左眼视力为20/60,眼压(IOP)为37 mmHg。观察到炎性细胞、前房积血和虹膜红变。所有实验室检查,包括使用房水进行的感染多重聚合酶链反应,均为阴性,眼底既无视网膜闭塞性血管炎也无视网膜缺血。我们的诊断是非感染性肉芽肿性前葡萄膜炎相关性NVG。局部糖皮质激素治疗和抗青光眼药物缓解了炎症、虹膜红变和NVG。治疗1个月时眼压降至13 mmHg,未观察到复发。
局部糖皮质激素可缓解非感染性前葡萄膜炎患眼中的虹膜红变和NVG。葡萄膜炎患眼中NVG的发病机制仍不清楚,但炎症可能在血管生成中起作用。抗炎治疗可作为前葡萄膜炎相关性NVG的首选治疗方法。