“The glaucoma NO‐ctail” the use of vasodilators and OCT‐A in ischemic optic‐nerve: Case report

Purpose: To highlight the value of enhancing the microcirculation of the optic nerve head, with a combination (cocktail) of vasodilators and at the same time the avoidance of vasoconstrictors (eg timolol). As well as, to point out the key contribution of OCT‐Angiography (OCT‐A) in the early diagnosis and monitoring of pathological microcirculation. Methods: A 68‐year‐old patient with ischemic optic nerve (OD) without stable antiglaucomatic treatment due to asthma, under Acetazolamide ¼ ×1 and vasodilator supplements (CoQ10, Bilberry extract/Pinus Pinaster), is presented with a significantly pale optic disc and incipient VF defects. BCVA OU: Logmar 0.1. IOP: 18/10 mmHg. RNFL: OD 74 μm OS 103 μmΑ large decrease in the peripapillary vascular density is detected in OCT‐A (peripapillary RPC density 37.3%). Ginkgo Biloba supplement is added and transcleral diode cyclophotocoagulation 180 ° is performed. Results: The following 6 months the IOP(OD) ranges from 11 to 14 mmHg. VF is stable and RNFL (OD) is slightly improved (78‐80 μm), while significant improvement in the peripapillary vascular density is shown in follow‐up OCT‐A after 5 months (peripapillary RPC density 44.4%). Conclusions: As OCT‐A shows, in patients with poor optic nerve microcirculation, the combination of early IOP reduction and the use of substances with vasodilating action, may have quite beneficial effects, possibly even stabilizing (if not reversing) RNFL thinning.