Secondary Neovascular Glaucoma in the Course of Diabetes in a Kidney Transplant Recipient: Case Report and Review of the Literature

Abstract

The increase in intraocular pressure during hemodialysis challenges nephrologists and ophthalmologists. It most often affects patients with previously diagnosed glaucoma and is particularly dangerous in the setting of diabetic retinopathy. Hypoperfusion and hypoxia of the retina may occur, leading to pathologic neovascularization in the retina and the anterior chamber angle. Changes in the filtration angle block the outflow of aqueous humor and cause secondary glaucoma. A special type of glaucoma is neovascular glaucoma, developing among others in patients with diabetic retinopathy. This study describes a patient with secondary neovascular glaucoma in whom a significant increase in intraocular pressure was observed during hemodialysis, not responding to the applied topical treatment. The patient experienced severe pain, and her cornea was constantly injured by paracentesis. Ultimately, secondary glaucoma led to a significant decrease in vision in both eyes. The patient was enrolled on a transplant waiting list and transplanted with priority. The patient experienced some urologic and infectious complications, although 7 months after transplantation, her creatinine concentration was 1.2 mg/dL, and the ocular disease was stabilized. The intraocular pressure decreased, but there were still values above the norm, which required periodic injections of anti-vascular endothelial growth factor into the vitreous chamber and 5-fluorouracil injections under the conjunctiva. Patients with diabetes and secondary neovascular glaucoma on dialysis constitute an extremely difficult therapeutic problem and require the involvement of several specialists. Successful kidney transplantation, besides ameliorating general clinical conditions, may increase the chance of successful ophthalmologic treatment.