A 58-year-old diabetic with ischemic central retinal vein occlusion developed rubeosis iridis three months after the occlusion. Intraocular pressure is 46 mmHg with an open angle showing new vessels crossing the trabecular meshwork. Which combination constitutes definitive management?
- A Topical timolol alone with observation
- B Trabeculectomy with mitomycin C as first step
- C Argon laser peripheral iridoplasty only
- D Panretinal photocoagulation combined with anti-VEGF injection ✓
Explanation
Neovascular glaucoma following ischemic CRVO, classically appearing around 90 days ('90-day glaucoma'), results from anterior segment ischemia driving angiogenic factor release. Definitive treatment ablates the ischemic retina with panretinal photocoagulation and uses anti-VEGF injection to cause rapid regression of neovascular vessels, lowering pressure and reducing hyphema risk before surgery if needed. Topical therapy alone cannot control the neovascular drive, iridoplasty does not address the source of VEGF, and filtering surgery fails in eyes with active neovascularization and poor prognosis.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.