Rapidly progressive neovascular glaucoma following coronary artery bypass graft surgery in a patient with type 1 diabetes mellitus: a case report

BACKGROUND: Proliferative diabetic retinopathy leading to vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma is a major cause of severe sight impairment in adults of working age worldwide. Neovascular glaucoma occurs in 2.5% of patients with proliferative diabetic retinopathy, which is difficult to treat and often leads to blindness. Onset of neovascular glaucoma with rapid progression to blindness within a few weeks of a successful coronary artery bypass graft procedure is not known with this clinical entity. CASE PRESENTATION: A 34-year-old white man with type 1 diabetes mellitus presented to our hospital with severe, rapidly progressive bilateral neovascular glaucoma following coronary artery bypass graft surgery. The patient was previously treated for proliferative diabetic retinopathy with complete peripheral pan-retinal photocoagulation. Prompt and adequate treatment with antiglaucoma medication and cyclodiode laser did not halt the progression of the disease. The patient ended up with no perception of light within a few weeks of initial presentation. CONCLUSIONS: Vision loss following coronary artery bypass graft surgery is usually associated with nonarteritic anterior ischemic optic neuropathy. Rapid progression to bilateral blindness resulting from neovascular glaucoma within a few weeks of presentation following coronary artery bypass graft is not a common presentation with this clinical entity. Our patient had been treated with erythropoietin-stimulating factor for severe anemia preceding and following his coronary artery bypass graft surgery. The improvement in ocular perfusion following coronary artery bypass graft surgery, coupled with the administration of erythropoietin-stimulating factor, could have contributed to the onset and rapid progression of neovascular glaucoma. Close monitoring of patients with proliferative diabetic retinopathy undergoing coronary artery bypass graft surgery, even if adequately treated, is advised because there is increased ocular morbidity leading to blindness.