A 58-year-old man developed marked visual loss from ischaemic central retinal vein occlusion two months ago. He now returns with a painful red eye, vision of counting fingers, intraocular pressure of 52 mmHg, and fine new vessels coursing over the pupillary margin and angle. Gonioscopy shows an open angle with neovascularization. The most likely diagnosis is:

• A Neovascular glaucoma ✓
• B Uveitic glaucoma
• C Posner-Schlossman syndrome
• D Steroid-induced glaucoma

Explanation

Neovascular glaucoma classically appears about 90 days after ischaemic central retinal vein occlusion, hence the old name ninety-day glaucoma. Rubeosis iridis begins at the pupillary margin and then extends into the angle, raising pressure through trabecular obstruction and later synechial closure. Management requires panretinal photocoagulation plus intensive IOP control. Posner-Schlossman is recurrent unilateral mild cyclitis with open angle and no rubeosis, and there is no history of steroid use here.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.