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Conjunctival Microangiopathy in a Patient with Neovascular Glaucoma.

Abdul-Rahman AM, Molteno A - Case Rep Ophthalmol (2015)

Bottom Line: Capillaries were tortuous, with sparse microaneurysm formation, and arterioles were attenuated.We are unaware of previous reports in the literature on conjunctival microangiopathy secondary to diabetes presenting as a red eye.We hypothesized that the clinical features in our case may have been modified by a combination of postoperative wound healing and degenerative vascular remodeling, in addition to microvascular alterations secondary to both diabetes and consequent ocular ischemia, which may have played a role.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Counties Manukau DHB, Auckland, New Zealand.

ABSTRACT

Purpose: To report a case of conjunctival microangiopathy secondary to diabetes presenting as a red eye 5 years after glaucoma implant surgery for neovascular glaucoma.

Materials and methods: A 52-year-old Tongan male with a past history of neovascular glaucoma secondary to proliferative diabetic retinopathy underwent slitlamp examination and color photography of the anterior and posterior segment, in addition to anterior segment fluorescein angiography.

Results: The conjunctival venules perilimbally demonstrated tortuosity and dilation (saccular, fusiform and tricornuate). Capillaries were tortuous, with sparse microaneurysm formation, and arterioles were attenuated. Anterior segment fluorescein angiography showed generalized iris ischemia, extensive perilimbal microvascular degenerative changes and leakage of fluorescein into the anterior chamber. We are unaware of previous reports in the literature on conjunctival microangiopathy secondary to diabetes presenting as a red eye.

Conclusions: We hypothesized that the clinical features in our case may have been modified by a combination of postoperative wound healing and degenerative vascular remodeling, in addition to microvascular alterations secondary to both diabetes and consequent ocular ischemia, which may have played a role.

No MeSH data available.


Related in: MedlinePlus

a Color photographs of the right eye demonstrating the predominance of conjunctival microangiopathy in the inferior bulbar conjunctiva. Pupillary and iris signs are obscured by dilation. b Microvascular abnormalities: venous dilation, beading, sacculation and tortuosity. Capillary tortuosity, microaneurysms and a reduction in density are shown. Arteriolar thinning results in an abnormal arteriolar/venular ratio.
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Figure 1: a Color photographs of the right eye demonstrating the predominance of conjunctival microangiopathy in the inferior bulbar conjunctiva. Pupillary and iris signs are obscured by dilation. b Microvascular abnormalities: venous dilation, beading, sacculation and tortuosity. Capillary tortuosity, microaneurysms and a reduction in density are shown. Arteriolar thinning results in an abnormal arteriolar/venular ratio.

Mentions: On examination at the current presentation, his visual acuity was 6/9 OD and 6/12 OS, and IOP was 18 mm Hg OU. Slitlamp examination of the anterior segment of the right eye revealed venular dilation, beading, focal dilation (saccular, fusiform and tricornuate) and tortuosity. Capillaries demonstrated microaneurysm formation and tortuosity, with attenuated arterioles. The vascular changes involved the bulbar conjunctiva circumferentially, predominantly inferonasally. The changes were absent over both the bulbar conjunctiva of the bleb wall and the tarsal conjunctiva. The cornea showed inferior nasal early arborescent neovascularization with a pseudopterygium 1.2 mm from the temporal limbus (fig. 1).


Conjunctival Microangiopathy in a Patient with Neovascular Glaucoma.

Abdul-Rahman AM, Molteno A - Case Rep Ophthalmol (2015)

a Color photographs of the right eye demonstrating the predominance of conjunctival microangiopathy in the inferior bulbar conjunctiva. Pupillary and iris signs are obscured by dilation. b Microvascular abnormalities: venous dilation, beading, sacculation and tortuosity. Capillary tortuosity, microaneurysms and a reduction in density are shown. Arteriolar thinning results in an abnormal arteriolar/venular ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608607&req=5

Figure 1: a Color photographs of the right eye demonstrating the predominance of conjunctival microangiopathy in the inferior bulbar conjunctiva. Pupillary and iris signs are obscured by dilation. b Microvascular abnormalities: venous dilation, beading, sacculation and tortuosity. Capillary tortuosity, microaneurysms and a reduction in density are shown. Arteriolar thinning results in an abnormal arteriolar/venular ratio.
Mentions: On examination at the current presentation, his visual acuity was 6/9 OD and 6/12 OS, and IOP was 18 mm Hg OU. Slitlamp examination of the anterior segment of the right eye revealed venular dilation, beading, focal dilation (saccular, fusiform and tricornuate) and tortuosity. Capillaries demonstrated microaneurysm formation and tortuosity, with attenuated arterioles. The vascular changes involved the bulbar conjunctiva circumferentially, predominantly inferonasally. The changes were absent over both the bulbar conjunctiva of the bleb wall and the tarsal conjunctiva. The cornea showed inferior nasal early arborescent neovascularization with a pseudopterygium 1.2 mm from the temporal limbus (fig. 1).

Bottom Line: Capillaries were tortuous, with sparse microaneurysm formation, and arterioles were attenuated.We are unaware of previous reports in the literature on conjunctival microangiopathy secondary to diabetes presenting as a red eye.We hypothesized that the clinical features in our case may have been modified by a combination of postoperative wound healing and degenerative vascular remodeling, in addition to microvascular alterations secondary to both diabetes and consequent ocular ischemia, which may have played a role.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Counties Manukau DHB, Auckland, New Zealand.

ABSTRACT

Purpose: To report a case of conjunctival microangiopathy secondary to diabetes presenting as a red eye 5 years after glaucoma implant surgery for neovascular glaucoma.

Materials and methods: A 52-year-old Tongan male with a past history of neovascular glaucoma secondary to proliferative diabetic retinopathy underwent slitlamp examination and color photography of the anterior and posterior segment, in addition to anterior segment fluorescein angiography.

Results: The conjunctival venules perilimbally demonstrated tortuosity and dilation (saccular, fusiform and tricornuate). Capillaries were tortuous, with sparse microaneurysm formation, and arterioles were attenuated. Anterior segment fluorescein angiography showed generalized iris ischemia, extensive perilimbal microvascular degenerative changes and leakage of fluorescein into the anterior chamber. We are unaware of previous reports in the literature on conjunctival microangiopathy secondary to diabetes presenting as a red eye.

Conclusions: We hypothesized that the clinical features in our case may have been modified by a combination of postoperative wound healing and degenerative vascular remodeling, in addition to microvascular alterations secondary to both diabetes and consequent ocular ischemia, which may have played a role.

No MeSH data available.


Related in: MedlinePlus