- Usually predisposed by hypoxia or ischemic state of the tissue.
- Most common predisposing conditions include diabetic retinopathy
and central retinal vein occlusion.
- Other causative factors include retinal detachment and other retinal
ischemic diseases.
- Clinical features:
- Early detection of rubeosis is usually around the region of
the pupillary margin and is best performed with an undilated pupil.
However, it maybe difficult to detect the new iris vessels in
a darkly pigmented iris.
- New fibrovascular tissue proliferation onto the chamber angle
may compromise the aqueous outflow and result in increased IOP.
- When the proliferation becomes more extensive, peripheral anterior
synechiae may occur with resultant secondary angle-closure glaucoma.
- Peripheral anterior synechiae may further cause a radial traction
along the surface of the iris and pull the pigment layer around
the iris pupillary margin anteriorly (ectropion uveae).
- Work up:
- Gonioscopic examination is of great clinical importance to
detect potential early angle vessel proliferation (prior to the
development of iris neovascularization).
- Iris or angle angiography and ERG may be useful to identify
early anterior segment neovascularization and peripheral retinal
ischemia prior to their obvious clinical presentation.
- Management:
- Treatment of the underlying disease and control of IOP.
- Prophylactic panretinal photocoagulation (PRP) in eyes with
proliferative diabetic retinopathy or ischemic central retinal
vein occlusion with new onset rubeosis.
- Medical therapy with topical ß-adrenergic antagonists,
a-2 agonists, and topical or oral carbonic inhibitors are beneficial
in lowering the IOP.
- Intraocular inflammation may be treated with topical corticosteroids.
- Pilocarpine and phospholine iodide are contraindicated because
they may increase inflammation, cause miosis, and worsen synechial
angle closure.
- Glaucoma surgery such as aqueous tube shunt surgery, cyclodestruction,
or antimetabolite-enhanced filtration surgery is indicated to
optimally control IOP if medical therapy has proven to be inadequate.
- For blind painful eyes with uncontrollable IOP, options include
continued medical therapy, cyclodestruction, retrobulbar alcohol
injection, or enucleation.
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