A 55-year-old diabetic with proliferative retinopathy presents with a 3-day history of eye ache and halos. Intraocular pressure is 34 mmHg. Gonioscopy shows fine new vessels crossing the angle with an open angle and no peripheral anterior synechiae. Visual acuity is 6/12 with clear media. What is the most appropriate immediate management?
- A Cyclocryotherapy to the ciliary body
- B Trabeculectomy with mitomycin C
- C Prompt panretinal photocoagulation combined with anti-VEGF therapy ✓
- D Ahmed glaucoma valve implantation
Correct answer: C. Prompt panretinal photocoagulation combined with anti-VEGF therapy
Explanation
Neovascularization of the iris with an open angle and clear media represents the window before synechial closure. The driver is retinal ischemia, so definitive treatment is prompt panretinal photocoagulation, with adjunctive anti-VEGF injection to cause rapid regression of the new vessels and lower pressure while the laser takes effect. Filtering surgery or tube implants are reserved for angle-closure neovascular glaucoma with uncontrolled pressure despite maximal medical and laser therapy.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.