Short-Term Successfully Management Therapy of Neovascular Glaucoma in Vogt- Koyanagi- Harada Syndrome: A Case Report

Abstract

Neovascular glaucoma (NVG) is one of many complications in Vogt-Koyanagi-Harada Syndrome (VKHS) patient. It will potentially blind if it is not treated properly A – 44 year old female presented to Hasanuddin University Hospital with decreased of vision since four months prior and an intermittent headache. Both eyes visual acuity showed hand movement, with IOP were 53 and 43 mmHg respectively. We found chronic uveitis, vitritis, exudative retinal detachment in BE and iris neovascularization only in right eye (RE). Patient received systemic methylprednisolone and carbonic–anhydrase also topical steroid and ß-blocker. Exudative retinal detachments resolved in both eyes after management. Iris neovascularization diminished after an intracameral anti VEGF injection.
Trabeculectomy with Mitomycin (MMC) performed in BE within 1-month interval. Synechiolisis, membranectomy and cataract extraction with implantation intraocular lens performed in LE 2 months later. Best corrected visual acuity (BCVA) in LE improved to 20/30 but decreased to 20/400 in 4 months. During 4 months follow-up, BE IOP remained stable in 16 mmHg and 11 mmHg respectively. Inflammation management is needed before any surgical procedure. Anti VEGF injection performed to deteriorate new vessels for transient effect and change in bleb vascularity. Trabeculectomy + MMC performed to enhance filtration and improve long-term bleb function. Visual acuity decreased after 4 months presumably because the chronic recurrent phase of VKHS. Managing ocular complication in VKHS is challenging due to chronic recurrences. An adequate inflammation therapy and comprehensive management are needed for controlling visual outcome and IOP in VKHS patient.