NEOVASCULAR GLAUCOMA AFTER CAROTID ENDARTERECTOMY

Neovascular glaucoma has been reported in the setting of carotid occlu sive disease. Its pathophysiology after carotid endarterectomy in this setting is unclear, and it may represent a unique entity. A patient w ho developed neovascular glaucoma shortly after ipsilateral carotid en darterectomy was examined and her clinical course. A 72-year-old women presented with visual loss in the left eye of 1 week's duration. A di agnosis of recanalized central retinal artery occlusion of the left ey e was made based on clinical examination and fluorescein angiogram. Af ter a medical evaluation revealed carotid occlusive disease, the patie nt underwent ipsilateral carotid endarterectomy. On follow up, she had an intraocular pressure of 38 mm Hg OS with diffuse rubeosis on gonio scopy. The patient underwent pan-retinal photocoagulation with complet e regression of rubeosis. We speculate that the sudden reperfusion aft er endarterectomy, which occurs in patients with combined central reti nal artery occlusion and carotid occlusive disease, may enhance the ci rculation of preformed angiogenesis factors, leading to the developmen t of neovascularization. Frequent and careful surveillance of patients with central retinal artery occlusion that is associated with carotid occlusive disease if an ipsilateral carotid endarterectomy is recomme nded.