RUBEOSIS OF THE IRIS IN PROLIFERATIVE VITREORETINOPATHY

Purpose: The authors report the findings and clinical course of rubeos is in patients with essentially reattached retinas after vitrectomy an d silicone oil for proliferative vitreoretinopathy (PVR). Methods: Fro m 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 detac hment. Results: Thirty-eight patients (38 eyes) were studied. Mean fol low-up after the appearance of rubeosis was 27 months (range, 6-66 mon ths). In all patients, peripheral residual retinal detachment coexiste d with rubeosis. Hypotony occurred in six patients. Cyclocryocoagulati on for neovascular glaucoma had been performed in four patients. The p eripheral detached retina was removed in 16 patients, resulting in tot al disappearance of rubeosis in 7 patients and regression in 4 more pa tients. In patients with visible, nonradially oriented iris vessels, t he authors found vessels in the anterior chamber angle crossing the tr abecular meshwork. The frequently present anterior synechiae in associ ation 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 presen t in all of these patients. Removal of this peripheral detached retina was statistically significantly associated with disappearance of rube osis, which suggests that the peripheral detachment was a causative fa ctor. Extensive anterior synechiae are not formed frequently in this c ondition. This may explain the infrequent (11%) occurrence of neovascu lar glaucoma. However, hypotony is more frequent.