Bilateral neovascular glaucoma associated with Radium-223 infusions for prostate cancer.

Purpose: To report two cases of neovascular glaucoma associated with Radium-223 infusion. Observations: Presented are two patients with metastatic prostate cancer who developed uncontrolled intraocular pressure secondary to neovascular glaucoma requiring surgical intervention. Both patients had received six cycles of Radium-223, a calcium mimetic that causes DNA double strand breaks and tumor cell death in bony metastases as part of their treatment regimen for metastatic prostate cancer. One patient had been a prior glaucoma suspect while the other had no significant ocular history. Conclusions and importance: Radium-223 may increase vascular permeability contributing to uveitis and promote angiostimulatory growth factors that can lead to neovascularization. We postulate this is through possible disruption in VEGF signaling pathways as well as Ra-223's calcium mimetic properties that could affect the trabecular meshwork. Neovascular glaucoma is uncommonly reported with Ra-223. There is one other case report that experienced uveitis and hyphema within weeks of the Ra-223 infusion. This case report has a similar proposed biologic mechanism. A literature review using the key words "radium-223, neovascularization, secondary angle closure glaucoma, neovascular glaucoma" did not yield any prior reports of neovascular glaucoma associated with Ra-223. The goal of this case series is to argue there is biological plausibility and to contribute to current literature of possible ocular complications of Ra-223 infusion.