First Author: P.Gouveia PORTUGAL
Co Author(s): S. Estrela-Silva F. Falcão-Reis 0 0 0 0 0 0 0 0 0
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To indicate vascular factor as a probable cause for open-angle glaucoma progression despite medically controlled intra-ocular pressure
Ophthalmology Department, Hospital São João, Porto, Portugal
A 74-year-old man was referred to our department due to elevated intra-ocular pressure (OD 28 mmHg, OS 28 mmHg). His past medical history included hypertension and dyslipidemia. After a complete ophthalmologic examination he was diagnosed with open angle glaucoma and treated with timolol+travoprost once daily. The 24-2 visual fields revealed an arcuate defect bilaterally. On follow-up visits medication was adjusted and intra-ocular pressure (IOP) control was achieved (OD 10 mmHg, OS 10 mmHg) with timolol+travoprost, brimonidine and dorzolamide. Despite a controlled IOP this patient’s visual fields revealed progression (superior and inferior arcuate defects). The investigation included a cerebral and orbital tomography, which were normal; a Doppler imaging of neck vessels that confirmed 80% stenosis of the right inner carotid artery (with hemodynamic repercussion) and 45% stenosis of the left inner carotid artery. The evaluation of retrobulbar blood flow velocities and resistance indexes revealed a borderline resistance index on both ophthalmic arteries and left central retinal artery. On the right central retinal artery the resistance index was elevated and the blood flow velocity was markedly reduced. The patient was proposed for a right carotid endarterectomy by his vascular surgeon.
An open angle glaucoma with controlled IOP that manifests progression warrants investigation. This case report illustrates an approach to that investigation. The evaluation of retrobulbar vessels provides valuable information and, in this patient, revealed that the carotid stenosis was, in fact, responsible for the hypoperfusion of the right optic nerve head and, consequently, responsible for the progression of the open angle glaucoma.