Sarcoidosis and rubeosis iridis

In this case of sarcoidosis the prominent ophthalmologic manifestation was neovascularization of the iris and of the angle, with glaucoma.     

Retinal cryocoagulation in rubeosis iridis

Patients with neovascularization of the iris were treated with cryocoagulation of the peripheral retina alone (Group A, n = 29), or in combination with cryocoagulation of the ciliary body (Group B, n = 19). The basic disease was either diabetic retinopathy or occlusion of the central retinal vein. After a follow-up of at least six months, a marked reduction in neovascularization of the iris was seen in most eyes. Intraocular pressure was reduced from a mean of 35.4 to 13.4 mm Hg in Group A, and from 55,2 to 6 mm Hg in Group B. A phthisis bulbi developed in six of 30 eyes (20%) in Group A and in 11 of 20 eyes (55%) in Group B.     

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.     

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.     

Neovascularization of the iris (rubeosis iridis)

This is a review of neovascularization of the iris and the neovascular glaucoma that often follows. With the aging of our population, this has become a more frequent cause of blindness and enucleation of eyes. Iris neovascularization is never primary, but is always secondary to other ocular disorders. The pathology is described based on the study of 110 globes. Diagnosis, pathogenesis and treatment are discussed.     

Hypotony and experimental rubeosis iridis in primate eyes

Rubeosis iridis was produced in cynomolgus monkeys by subjecting their eyes to severe surgically induced hypotony. New vessels on the iris showed characteristic fenestrations of endothelial cell walls as well as mitotic activity.     

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.     

Photocoagulation in diabetic rubeosis iridis and neovascular glaucoma

This retrospective study was performed to examine the effect of retinal coagulation on the course of iris neovascularization and neovascular glaucoma in patients with diabetic retinopathy. Sixty-four eyes in 42 patients were examined. Following retinal coagulation iris neovascularization regressed in 47 eyes (73%), while 17 eyes (27%) showed no improvement. In eyes with neovascular glaucoma, a drop in intraocular pressure was noted. Visual acuity decreased in 60% of the treated eyes. Regression of iris neovascularization was related to the number of burns applied.     

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.