Morphological study of rubeosis iridis induced in animal eyes]

Rubeosis iridis was produced experimentally in rhesus monkey eyes, by means of occlusion of the major retinal vessels of the retina and persistent ocular hypotony. Clinically, rubeosis iridis was recognized 5 days after the procedure. Histopathologically, these vessels developed anteriorly to the iris surface and endothelial fenestrations showed evidence of iris neovascularization. Endothelial cells of the vessels projected toward the internal lumen and showed immaturity. Newly formed vessels originated from the stromal vessels in the iris. This method is an effective experimental model for the induction of rubeosis iridis.     

Preliminary report on effect of retinal panphotocoagulation on rubeosis iridis and neovascular glaucoma.

Eight eyes with central retinal vein occlusion one eye with old central retinal artery occlusion complicated by rubeosis iridis or increased intraocular pressure, or both; and one eye with diabetic retinopathy and rubeosis iridis were treated by retinal panphotocoagulation. Vision did not improve but intraocular pressure was lower and iris neovascularisation regressed in most cases, supporting the hypothesis that retinal hypoxia is a cause of iris neovascularisation and suggesting that retinal panphotocoagulation has a potential prophylactic and therapeutic role in rubeosis iridis and early neovascular glaucoma.     

Experimental immunogenic rubeosis iridis.

We have developed a primate model of rubeosis iridis in monkeys systemically sensitized to crystalline beef insulin. After intravitreal insulin injection, the dose-related immunogenic inflammation includes cells, flare, fibrin, and blood in the anterior chamber. With more severe inflammation, posterior synechiae, iris bombé, and cataracts occur. Of particular importance, new blood vessels develop within the stroma and on the anterior surface of the iris. Following injection of small amounts of insulin, the anterior surface vessels may regress over time, and the iris regains its normal appearance and coloration. However, the new stromal vessels persist and are cuffed by inflammatory cells including plasma cells. After injection of large amounts of insulin, more extensive structural alterations develop as noted above in conjunction with persistent iris anterior surface and stromal neovascularization. The relationship of rubeosis iridis to clinical inflammatory syndromes and to previous laboratory studies is discussed. Stromal neovascularization was a consistent finding in this experimental model even when anterior surface vessels regressed. On the basis of these experimental data and a review of publications describing human pathology, we believe that a broadening of the classic definition of rubeosis iridis is waranted to include a recognition of the stromal component of the clinical and pathologic findings.     

Effect of pan-retinal photocoagulation in iris neovascularization]

The authors were able to produce experimental rubeosis iridis in the rhesus monkey's eye on 5 days following occlusion of the major retinal vessels and persistent ocular hypotony. Histopathological examination revealed true neovascularization. This experiment attempted to see whether laser pan-retinal photocoagulation plays an inhibiting effect on the occurrence of rubeosis iridis or not. We first performed laser pan-retinal photocoagulation, and at the same time performed occlusion of the major retinal vessels and persistent hypotony to aid for rubeosis iridis. Clinically, rubeosis iridis appeared within 5 days. At 14 days, histological examination revealed vessels on the surface of the iris following pan-retinal photocoagulation treatment were covered by fibroblast and melanocyte, and their endothelial cells showed no fenestrations. This means that clinical rubeosis iridis is not true neovascularization, but dilatation of the iris vessels. Thus, it was confirmed that pan-retinal photocoagulation inhibits development of iris neovascularization.     

荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.     

Clinical correlation between rubeosis iridis and optic disc neovascularization (author's transl)

Clinical findings and fluorescein angiographies of 293 eyes affected with proliferative diabetic retinopathy were reviewed with the specific aim of looking for a possible correlation between rubeosis iridis and the localization of the new vessels in the ocular fundus. In this series there was a highly significant correlation between rubeosis iridis and optic disc new vessels. Rubeosis iridis was present in 49% of the eyes with optic disc new vessels against only 5.5% of the eyes with retinal new vessels not associated with optic disc new vessels. Among the 97 eyes affected with rubeosis iridis, 91 (93.8%) had also optic disc neovascularization. This clinical correlation allows for predicting which of the eyes affected with proliferative diabetic retinopathy are at a high risk of developing rubeosis iridis. In addition to this, this clinical correlation leads to the hypothesis that there is uveal hypoxia associated to retinal hypoxia in those eyes with rubeosis iridis. Thus iris new vessels may result from uveal hypoxia rather than from retinal hypoxia.     

Vitrectomy and subsequent photocoagulation in proliferative diabetic retinopathy with vitreous hemorrhage

Forty eyes in 39 patients with proliferative diabetic retinopathy, vitreal hemorrhage and progressive neovascularization in at least 3 fundus quadrants were treated with panretinal xenon photocoagulation immediately after pars plana vitrectomy. Lens extraction was performed on 7 eyes and 2 eyes were aphakic. Six months after treatment, 68% of the eyes showed an improvement in vision, 25% had vitreal rebleeding and 11% developed rubeosis iridis. While treatment had no effect on peripheral rubeosis iridis in 5 eyes, all 7 eyes with pupillary rubeosis iridis showed complete regression. The results indicate the clinical value of combining, pars plana vitrectomy with panretinal xenon photocoagulation in selected patients.     

Rubeosis iridis: preoperative iris fluorescein angiography and periocular steroids

To study the risk of developing rubeosis iridis following vitrectomy, the use of preoperative iris fluorescein angiography was prospectively investigated on patients with diabetes mellitus, without any clinically detectable iris or angle neovascularization. With increasing severity of fluorescein leakage, the risk of iris neovascularization with or without glaucoma, six months after vitreous surgery, is significantly increased. It was also determined whether postoperative steroid therapy (periocular triamcinolone acetonide and topical prednisolone phosphate) reduces the risk of developing iris neovascularization after vitrectomy. Controlled and treated patient eyes did not differ significantly in the degree of rubeosis. However, neovascular glaucoma statistically occurred more frequently in the nonsteroid group.     

Regression of diabetic rubeosis iridis following successful surgical reattachment of the retina by vitrectomy

The relationship between successful surgical reattachment of the retina following diabetic vitrectomy and regression of preoperative rubeosis iridis was investigated. Seventy-nine (9.2%) of 850 diabetic cases undergoing vitrectomy had both preoperative iris rubeosis and retinal detachment. The iris could be adequately evaluated and the retina could be visualized after surgery in 36 cases. Regression of the rubeosis iridis occurred after surgery in 16 (76%) of 21 eyes in which the retina was reattached successfully. Only four (27%) of 15 eyes had regression of rubeosis iridis when the retina was not reattached completely. Retention of the lens also correlated with regression of rubeosis iridis. Regression occurred in 10 (55%) of 18 cases in which the lens was not removed, 13 (28.2%) of 46 eyes in which lensectomy was combined with vitrectomy, and none of eight previously aphakic eyes. Although the combination of preoperative retinal detachment and rubeosis iridis is associated with a worsened prognosis, successful reattachment of the retina and retention of the lens favorably influence later regression of preoperative rubeosis iridis.     

Auto-cortex of crystalline lens-induced iris neovascularization

AIM：To investigate auto-cortex of crystalline lens induced iris neovascularization (INV). METHODS: Thirty-six eyes of 36 guinea-pigs were included and divided into three groups randomly in this cohort study. Group A: the right lens nucleus was extracted and the remaining cortical lens material was aspirated thoroughly. Group B: the lens was removed and 30μL precipitated lens cortex was injected into the anterior chamber again. Group C: aspirated the lens cortex of the left eyes and inject them into the right anterior chambers about 10μL. Clinical changes were followed by slit-lamp examination and photograph. The eye balls were enucleated at the day of 2, 4, 7, 11, 13, 17 after operation. HE was used to detect the pathological changes. RESULTS：Group A：INV had not been observed until the end of empirical study. The stromal layer contained thick wall vessels, without expansion. Group B: All eyes developed INV. Postoperative (po) 7 days; the eyes developed intense and extensive INV. The vessels of iris expanded remarkably and neovascularization was observed erupting from it’s lateral wall and stretching towards the anterior surface. Po11 days, INV regressed gradually after lens cortex had been absorbed. Group C: Po four（4） days, new blood vessels liking red line were presented on the anterior surface of the iris and they were not obvious. CONCLUSION: Anterior chamber inside lens coriaceous can induce iris new blood vessels.     

Iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

PURPOSE: To analyze the incidence of iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation using a small incision in the treatment of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: We studied a consecutive series of 46 eyes in which vitrectomy combined with phacoemulsification and IOL implantation had been performed, and compared the surgical results with a prior series of 40 eyes in which vitrectomy alone had been performed. RESULTS: Postoperative iris and angle neovascularization was found in 6 eyes (15%) treated by vitrectomy alone, but in only 1 eye (2%) treated by combined vitrectomy (P<0.05). Final visual acuity improved by two or more lines in 23 eyes (57%) in the vitrectomy alone group, and in 35 eyes (76%) in the combined vitrectomy group. CONCLUSIONS: The incidence of postoperative rubeosis iridis was significantly lower, and the visual results were satisfactory with vitrectomy combined with phacoemulsification and IOL implantation for PDR. These findings suggest that combined vitrectomy for PDR is a useful surgical procedure.     

Rubeosis iridis in "pseudogliomas"

A total of 85 eyes (75 patients) with pseudogliomas (i.e., certain conditions which simulate retinoblastoma, were examined histopathologically to determine the incidence of rubeosis iridis. Neovascularization of the anterior surface of the iris was found in 70 eyes (82%). The principal associated changes in these eyes were moderate to severe inflammation of the uveal tract and retinal detachment. These findings are interpreted as indicating that inflammation, retinal detachment, and/or ischemia are effective stimulants in producing iris neovascularization, and rubeosis is not a significant factor in differentiating eyes with retinoblastoma from those eyes with pseudogliomas.     

The association of rubeosis iridis with endothelialisation of the anterior chamber: report of a clinical case with histopathological review of 16 additional cases.

A patient is reported in whom the clinical observation of extension of the corneal endothelium and Descemet's membrane in association with rubeosis iridis was confirmed by histopathological examination. In a study of eyes which had been removed and demonstrated rubeosis iridis and secondary glaucoma in 16 additional eyes revealed extension of the corneal endothelium and Descemet's membrane on to the anterior iris surface. In all instances the transition occurred at the pseudoangle formed by the attachment of peripheral anterior synechiae. The suggestion is made that the fibrovascular membrane of rubeosis iridis is the stimulus which excites the extension of the endothelium on to the iris surface. The association between rubeosis iridis and extension of the corneal endothelium and Descemet's membrane on to the iris has not been previously appreciated.     

Regression of neovascular posterior capsule vessels by intravitreal bevacizumab

We present a 76-year-old woman who developed neovascularization of the posterior capsule 1 year after extracapsular cataract extraction. She had type 2 diabetes for 15 years, with proliferative diabetic retinopathy that had been treated with panretinal photocoagulation. The neovascular vessels on the posterior capsule originated from existing rubeosis iridis and regressed after a single injection of intravitreal bevacizumab (Avastin). The patient's visual acuity increased to 20/40 after an uneventful neodymium:YAG capsulotomy.     

Fluorescein angiography of extreme peripheral retina and rubeosis iridis in proliferative diabetic retinopathy.

PURPOSE: To study the fluorescein angiographic appearance of the extreme peripheral retina in patients with proliferative diabetic retinopathy with rubeosis iridis. METHODS: Using a modified endoscope, fluorescein angiography was performed prospectively during pars plana vitrectomy on 14 eyes of 12 patients with proliferative diabetic retinopathy who had or developed postoperative rubeosis. These findings were compared with those obtained from 41 eyes of 35 patients without rubeosis. RESULTS: A fibrovascular ridge was observed at the ora serrata in 11 of 12 eyes (92%) with rubeosis but in only 15 of 35 (43%) eyes without rubeosis. Seven of 12 (58%) eyes with rubeosis showed the continuous type of fibrovascular ridge, whereas only 5 of 35 (14%) eyes without rubeosis showed the continuous type. A broom-shaped continuous fibrovascular ridge was observed only in eyes with rubeosis. CONCLUSIONS: Many eyes with proliferative diabetic retinopathy showed unusual findings in the extreme retinal periphery, which were more frequent in the eyes with rubeosis iridis. Fluorescein angiography of this region may provide valuable information for possible anterior neovascularization.     

Pinwheel rubeosis iridis following argon laser coreoplasty.

Rubeosis iridis developed in the right eye of a 10-year-old boy with Marfan's syndrome. This eye had a chronic retinal detachment which we could study adequately only after coreoplasty of the iris was carried out with the argon laser. The purpose of this paper is to describe our experience using the argon laser for coreoplasty, and to report the unique pinwheel configuration of the iris neovascularization that developed around the laser lesions. We believe the rubeosis iridis was most likely a sequelae of the chronic retinal detachment, and that the atrophic laser lesions probably acted as templates for the neovascularization, giving rise to its peculiar configuration.     

The myofibroblastic component of rubeosis iridis

Nineteen blind eyes enucleated for painful angle closure-glaucoma secondary to iris neovascularization (rubeosis iridis) were examined by scanning electron microscopy and correlative light and transmission electron microscopy. Fresh and deparaffinized tissue from patients with diabetes mellitus, central retinal vein occlusion, and retinoblastoma were studied. Scanning electron microscopy revealed extensive peripheral anterior synechia formation and flattening and effacement of the anterior iridic surface by a confluent fibrovascular membrane. New vessels on the anterior iris uniformly were hidden beneath a clinically inapparent, superficial layer of myofibroblasts, ie, fibroblastic cells with smooth muscle differentiation. Myofibroblasts may provide the motive force for synechial closure and ectropion iridis in neovascular glaucoma.     

Ophthalmic artery blood flow in patients with internal carotid artery occlusion

AIM: To evaluate the risk factors for rubeosis iridis by colour Doppler imaging (CDI) in patients with complete internal carotid artery occlusion (ICAO). METHODS: 34 eyes of 32 consecutive patients with complete ICAO were enrolled. Using CDI, blood flow direction (forward, reverse, undetectable) in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) were determined. Arterial mean blood velocity (Vmean) and resistive index (RI) were calculated and correlations between the rubeosis iridis incidence and CDI parameters analysed. RESULTS: The eyes were classified into four types according to blood flow direction: forward flow in OA, CRA, and SPCA (type 1; n = 11); reverse OA and forward CRA and SPCA flow (type 2a; n = 12); reverse OA and undetectable CRA and SPCA flow (type 2b; n = 8); undetectable flow in all three arteries (type 3; n = 3). Rubeosis iridis was seen only in type 2b and 3 eyes. Type 2b showed significantly (p<0.01) higher Vmean and lower RI values in the OA, indicating more rapid reverse flow than in type 2a eyes. Although in type 1 and 2a eyes OA flow was in opposite directions, they manifested no rubeosis iridis and no difference in the Vmean and RI values of the CRA and SPCA. CONCLUSIONS: The classification of eyes from patients with ICAO into four types by CDI may facilitate the identification of the eyes at high risk for rubeosis iridis. Markedly diminished flow in both the CRA and SPCA may result in rubeosis iridis, regardless of OA flow direction.     

Indocyanine green iris angiography of lung carcinoma metastatic to the iris

· Background: To investigate the usefulness of indocyanine green (ICG) iris angiography for monitoring vascular abnormalities and the clinical course of metastatic iris tumor during chemotherapy. · Methods: We performed ICG iris angiography at several points during systemic chemotherapy for a 67-year-old man who had been diagnosed as having small-cell carcinoma of the lung with metastatic iris tumors. · Results: ICG iris angiography clearly demonstrated hyperfluorescent tumor vessels, rubeosis iridis, and dilated iris stromal vessels. After chemotherapy, these hyperfluorescent vessels and rubeosis regressed. · Conclusion: ICG iris angiography appears to be an effective and useful method for observing abnormal vessels associated with metastatic iris tumors. Received: 11 May 1998 Revised version received: 30 July 1998 Accepted: 13 August 1998     

Dilation of the minor arterial circle of the iris preceding rubeosis iridis during retinal vein occlusion

PURPOSE: To report in four patients with retinal vein occlusion the presence of biomicroscopically visible circulation in the minor arterial circle of the iris, preceding rubeosis iridis in two cases. DESIGN: Retrospective observational case series. METHODS: Four patients with ischemic type of central or hemi-central retinal vein occlusion seen at a single center. RESULTS: Dilation of the minor arterial circle remnants with biomicroscopically visible circulation was observed in four eyes of four adult patients with severe retinal ischemia secondary to retinal vein occlusion and preceded the occurrence of anterior segment neovascularization in two cases. CONCLUSION: In patients with ischemic retinal vein occlusion, the clinical finding of a dilation of the minor arterial circle may indicate the necessity of a closer follow-up to make a timely decision on panretinal photocoagulation.