A 58-year-old diabetic man develops neovascular glaucoma with rubeosis iridis and an intraocular pressure of 50 mmHg. Besides medical lowering of pressure, which intervention addresses the fundamental driving mechanism of the neovascularization?

• A Topical pilocarpine four times daily
• B Laser peripheral iridotomy
• C Argon laser trabeculoplasty
• D Panretinal photocoagulation ✓

Explanation

Neovascular glaucoma is driven by anterior segment diffusion of vascular endothelial growth factor produced by ischemic retina. Panretinal photocoagulation ablates the ischemic retina, removes the angiogenic stimulus, and leads to regression of rubeosis iridis. Anti-VEGF injections give rapid short-term regression but the durable treatment of the source is retinal ablation. Trabeculoplasty is useless in a closed or membrane-covered angle, and miotics worsen inflammation.

Reference: Yanoff and Duker, Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.