A 54-year-old diabetic presents with blurred vision and ocular ache. Slit lamp shows iris neovascularization, gonioscopy shows an open angle with early vessel extension onto the trabecular meshwork, intraocular pressure is 34 mmHg, and the retina is visible with active disc neovascularization. Visual acuity is 6/36 with potential for recovery. What is the most appropriate immediate management strategy?
- A Diode cyclophotocoagulation to lower pressure definitively
- B Intravitreal anti-VEGF injection promptly followed by panretinal photocoagulation ✓
- C Trabeculectomy with mitomycin C once inflammation settles
- D Topical maximal medical therapy alone with review after three months
Correct answer: B. Intravitreal anti-VEGF injection promptly followed by panretinal photocoagulation
Explanation
With an open angle and recoverable vision, the priority is rapid regression of neovascularization. Intravitreal anti-VEGF lowers VEGF levels within days and can transiently control pressure and halt angle invasion, but the effect is temporary, so prompt complete PRP must follow to treat the underlying retinal ischemia. Cyclodestruction is reserved for eyes with no useful visual potential, which does not apply here, ruling out option A.
Reference: AAO Basic and Clinical Science Course, Section 12: Retina and Vitreous, 2023-2024 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.