Glaucoma Research and Clinical Facility, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2019 Feb;67(2):285-287. doi: 10.4103/ijo.IJO_1288_18.
A 45-year-old diabetic male, with diabetic retinopathy and medically uncontrolled neovascular glaucoma (NVG) underwent intracameral bevacizumab followed by trabeculectomy, with controlled intraocular pressures (IOP) post-operatively, OD: 12 mmHg; OS: 14 mmHg. Patient was referred to hematology, where he was diagnosed as chronic myeloid leukemia (CML) and started on imatinib mesylate. Thereafter, he presented with recurrence of neovascularization and vascularization of the bleb along with OS vitreous hemorrhage at 6 weeks follow-up. While he was planned for OS vitreo-retinal surgery, he presented with OD spontaneous hyphema with raised IOP (OD: 38 mmHg, OS: 16 mmHg). He had maintained a tight glycemic control. Following imatinib therapy, there was a rapid progression and recurrence of neovascularization, eventually leading to failure of trabeculectomy OD and bilateral severe loss of vision. Imatinib may be implicated in the worsening of NVG in CML patients, especially with co-existing diabetes and thus, such patients should receive regular thorough ophthalmic evaluation as long as imatinib continues.
一位 45 岁的糖尿病男性，患有糖尿病视网膜病变和药物无法控制的新生血管性青光眼（NVG），接受了房内注射贝伐单抗，随后进行小梁切除术，术后眼压得到控制，右眼：12mmHg；左眼：14mmHg。患者转至血液科，被诊断为慢性髓性白血病（CML），并开始服用甲磺酸伊马替尼。此后，他在 6 周随访时出现新生血管和滤过泡血管化以及左眼玻璃体积血复发。在计划进行左眼玻璃体视网膜手术时，他右眼出现自发性前房积血伴眼压升高（右眼：38mmHg，左眼：16mmHg）。他一直保持严格的血糖控制。在接受伊马替尼治疗后，新生血管迅速进展和复发，最终导致右眼小梁切除术失败，双眼严重视力丧失。伊马替尼可能与 CML 患者 NVG 的恶化有关，特别是与并存的糖尿病有关，因此，只要继续使用伊马替尼，此类患者就应接受定期全面的眼科评估。
