Successful stent implantation in the internal jugular vein occlusion using Brockenbrough needle under intravascular ultrasound guidance leading to prevention of vision loss in a hemodialysis patient with neovascular glaucoma.

Central venous occlusion (CVO) remains an unresolved issue in hemodialysis patients. We herein present an interesting case of a 42-year-old hemodialysis female patient with complete vision loss in the left eye, who was at high risk of losing vision in her right eye because of neovascular glaucoma (NVG). Computed tomography (CT) showed occlusion of the right internal jugular vein (IJV) just above the junction with the right innominate vein. From the configuration and location of the lesion, it was concluded the occlusion had been caused by venous valvular degeneration. Her NVG with progressive intraocular pressure (IOP) elevation was presumably attributed to the right IJV occlusion. The extra-rigid occlusive lesion was successfully penetrated by means of a Brockenbrough needle and subsequently implanted with a balloon-expandable stent. Intravascular ultrasound (IVUS) guidance allowed us to manipulate the Brockenbrough needle safely. After stent implantation, the right IOP declined dramatically, resulting in the preservation of her eyesight. <Learning objective: Neovascular glaucoma (NVG) is a devastating disease for the occurrence of which various factors are responsible. In this report, the occlusion of the right internal jugular vein was determined as the main cause of the elevated intraocular pressure, which had led to the deterioration of her NVG. Stent implantation provided an immediate reduction in intraocular pressure. The Brockenbrough needle was safely manipulated under intravascular ultrasound guidance.>.