Neovascular glaucoma is a rare cause of elevated intraocular pressure and is typically caused by severe posterior segment ischemia resulting in anterior segment ischemia and neovascularization of the trabecular meshwork angle. Diabetic retinopathy, ischemic central retinal vein occlusion and ocular ischemic syndrome account for the three most common causes of neovascular glaucoma. When a patient’s clinical picture is not consistent with these more common etiologies, other rarer causes of posterior segment ischemia, including chronic retinal detachments, ocular inflammation, and intraocular tumors, must be investigated. We present a case of a patient with neovascular glaucoma secondary to a presumptive diagnosis of sickle cell retinopathy. While this patient’s exam was not consistent with a classic presentation of sickle cell retinopathy, a negative workup of diabetic retinopathy, ischemic CRVO, ocular ischemic syndrome, retinal detachment, intraocular tumor, and ocular inflammation resulted in a presumptive diagnosis of neovascular glaucoma secondary to sickle cell retinopathy. Our case reviews the pathophysiology, epidemiology, and presentation of sickle cell retinopathy. We furthermore discuss its controversial management consisting of laser, anti-VEGF injections, and systemic medications, all of which do not have standardized treatment protocols. Complicating sickle cell retinopathy management is the rareness of this disease entity causing neovascular glaucoma. Our case highlights the workup of a diagnostic dilemma and the treatment of an uncommon disease entity.
Presentation Date: 07/29/2021
Issue Date: 09/24/2021