A 58-year-old man with a history of ischemic central retinal vein occlusion (CRVO) presents 4 months after the initial event with pain, decreased vision, and an intraocular pressure of 52 mmHg. Slit-lamp examination shows iris neovascularization and angle neovascularization on gonioscopy. Which is the most urgent next step in management?

• A Panretinal photocoagulation (PRP) ✓
• B Intravitreal anti-VEGF injection alone
• C Anterior chamber paracentesis
• D Topical beta-blocker and oral acetazolamide only

Explanation

Neovascular glaucoma in ischemic CRVO requires urgent panretinal photocoagulation to reduce the ischemic drive producing VEGF. Anti-VEGF can be adjunctive for rapid regression of iris neovascularization, but PRP addresses the underlying retinal ischemia. Topical and systemic IOP-lowering agents are temporizing measures but do not treat the cause. The CVOS established PRP once iris neovascularization develops.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.