Neovascularization in the Iris: Rubeosis Iridis

Neovascularization in the Iris: Rubeosis Iridis

Definition:

Rubeosis iridis is neovascularization in the iris that occurs in various retinal dis-orders.

Etiology: 

The most frequent causes of rubeosis iridis (Fig. 8.12) areprolifera-tive diabetic retinopathy and retinal vein occlusion. Retinal periphlebitis is aless frequent cause of neovascularization in the iris.

Symptoms and diagnostic considerations: 

Neovascularization in thestroma of the iris isasymptomaticfor the patient. Neovascularization in the angle of the anterior chamber is irreversible and produces secondary angleclosure glaucoma with the typical symptoms of acute glaucoma: loss of visual acuity, intense pain, conjunctival and ciliary injection, and a “rock hard” eye-ball upon palpation (see Fig. 10.17).

Differential diagnosis: 

Acute glaucoma due to other causes such as acuteangle closure glaucoma should be excluded.

Treatment, prognosis, and prophylaxis: 

Rubeosis iridis is essentially tanta-mount to the loss of an eye. Usually it leads to irreversible blindness. Prompt laser treatment of retinal disorders is crucial to prevent rubeosis iridis. Sec-ondary angle closure glaucoma is treated by transscleral freezing of the ciliary body (cyclocryotherapy) to reduce intraocular pressure. Where this fails or the eye shrinks (phthisis bulbi) and the patient experiences intense pain, enucleation of the eye is indicated.

Prompt laser treatment is important in proliferative diabetic retinopathy to prevent rubeosis iridis.