Rubeosis of the iris in proliferative vitreoretinopathy

PURPOSE: The authors report the findings and clinical course of rubeosis in patients with essentially reattached retinas after vitrectomy and silicone oil for proliferative vitreoretinopathy (PVR).

METHODS: From 1989 on, the authors prospectively noted all patients with rubeosis and with attached retina posterior to the buckle after vitrectomy and silicone oil for PVR as a complication of rhegmatogenous retinal detachment.

RESULTS: Thirty-eight patients (38 eyes) were studied. Mean follow-up after the appearance of rubeosis was 27 months (range, 6-66 months) in all patients, peripheral residual retinal detachment coexisted with rubeosis. Hypotony occurred in six patients. Cyclocryocoagulation for neovascular glaucoma had been performed in four patients. The peripheral detached retina was removed in 16 patients, resulting in total disappearance of rubeosis in 7 patients and regression in 4 more patients. In patients with visible, nonradially oriented iris vessels, the authors found vessels in the anterior chamber angle crossing the trabecular meshwork. The frequently present anterior synechiae in association with vessels never totalled more than three clock hours (except in the four patients who underwent cyclocryocoagulation).

CONCLUSIONS: Detached retina peripheral to dense photocoagulation scars was present in all of these patients. Removal of this peripheral detached retina was statistically significantly associated with disappearance of rubeosis, which suggests that the peripheral detachment was a causative factor. Extensive anterior synechiae are not formed frequently in this condition. This may explain the infrequent (11%) occurrence of neovascular glaucoma. However, hypotony is more frequent.