Features of iris and fundus fluorescein angiography in diabetic iridopathy / 中华实验眼科杂志

Objective:To investigate the imaging features of iris fluorescein angiography (IFA) combined with fluorescein fundus angiography (FFA) in diabetic iridopathy.Methods:A cross-sectional study was conducted.Sixty-five eyes of 44 patients with proliferative diabetic retinopathy (PDR) combined with diabetic iridopathy (DI) were enrolled in Henan Eye Hospital from May 2013 to May 2020.Patients were divided into non-proliferative diabetic iridopathy (NPDI) group and rubeosis iridis group according to the imaging results.Ophthalmic examinations including visual acuity, intraocular pressure, slit lamp miacroscopy, IFA and FFA were carried out in all patients.IFA was used to detect the iris imaging characteristics and the regression time of fluorescein in anterior chamber, and FFA was used to observe the retinal image characteristics and the incidence of optic disc neovascularization.To avoid the statistical error of recording the IFA examination time of the contralateral eye, only the relevant data of the affected eyes were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2020[06]). Written informed consent was obatined from all patients before any medical examination.Results:Among the patients, 30 cases (50 eyes) were with NPDI and 14 cases (15 eyes) were with rubeosis iridis.The fluorescein regression time in anterior chamber of NPDI group was (3.37±0.11) minutes, which was significantly shorter than (6.02±0.29) minutes of rubeosis iridis group ( t=8.541, P<0.001). Strong fluorescence of retinal neovascularization was observed in both groups.The incidence of optic disc neovascularization in NPDI group was 20% (6/30), which was significantly lower than 50% (7/14) in rubeosis iridis group ( P=0.04). Conclusions:Diabetic rubeosis iridis can be diagnosed by the imaging features of IFA and the fluorescein regression time in anterior chamber.PDR combined with optic disc neovascularization should be evaluated by FFA combined with IFA.

Mydriasis induced hyphema in a patient with rubeosis iridis.

Hyphema is the presence of blood in the anterior chamber of the eye. The blood may completely or partially cover the pupil and cause decrease in visual acuity. Other signs and symptoms of hyphema include visible blood in the front of the eye, pain, and sensitivity to light. The most common cause of hyphema is ocular trauma, usually a blunt or lacerating one. Other causes of hyphema include intraocular surgery, eye infections caused by herpes virus, cancer of the eye, artificial lens implants and blood clotting problems such as hemophilia, sickle cell anemia and von Willebrand disease. Hyphema may also occur spontaneously in conditions such as rubeosis iridis, juvenile xanthogranuloma, myotonic dystrophy and iris melanoma. The purpose of this case report is to point to the management of hyphema which occurs after administration of mydriatic drugs.

The management of complicated glaucoma.

Complicated glaucomas present considerable diagnostic and management challenges. Response to treatment can be unpredictable or reduced compared with other glaucomas. However, target intraocular pressure and preservation of vision may be achieved with selected medical, laser and surgical treatment. The evidence for such treatment is expanding and consequently affords clinicians a better understanding of established and novel techniques. Herein we review the mechanisms involved in the development of complicated glaucoma and the current evidence supporting its management.

Comportamiento clínico epidemiológico del glaucoma neovascular en un servicio de glaucoma / Clinical epidemic behavior of the neovascular glaucoma in a glaucoma service

Entre las enfermedades oculares, el glaucoma, está contemplado entre aquellas que más cambios han sufrido en muchos de sus variados aspectos con el decursar de los años. Objetivo: Describir el comportamiento clínico epidemiológico del glaucoma neovascular en el Servicio de Glaucoma del Centro Oftalmológico Carlos J Finlay de la provincia de Camagüey. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo para determinar el comportamiento clínico epidemiológico del glaucoma neovascular en pacientes atendidos en dicho centro durante el período del 1 de enero del 2006 al 31 de octubre del 2007. El universo estuvo constituido por sesenta pacientes y la muestra quedó constituida por cincuenta y dos de ellos. Las variables estudiadas fueron: grupos de edades, sexo, color de la piel, antecedentes patológicos personales generales, antecedentes patológicos personales oculares, síntomas, signos, agudeza visual y variantes de tratamiento en cada paciente. Resultados: Se encontraron un total de cincuenta y dos pacientes con glaucoma neovascular. Predominaron el grupo de edades de más de 60 años, el sexo masculino y la raza blanca. Primó la Diabetes Mellitus como antecedente patológico personal general y la Retinopatía Diabética como antecedente patológico ocular. Conclusiones: El glaucoma neovascular ocupa un lugar importante dentro de la oftalmología, si se tiene en cuenta sus fatales consecuencias oculares, se expone la descripción de sus características.

Among the ocular diseases, glaucoma is considered among those that more changes have suffered in many of its varied aspects with the course of the years. Objective: To describe the clinical epidemic behavior of the neovascular glaucoma in the Glaucoma Service at the Ophthalmologic Center Carlos J Finlay" of Camagüey province. Method: A descriptive, longitudinal and retrospective study was conducted to determine the clinical epidemic behavior of the neovascular glaucoma in patients attended in the Glaucoma Service at the Ophthalmologic Center Carlos J. Finlay of Camagüey province from January 1st, 2006 to October 31st, 2007. The universe was constituted by sixty patients and the sample was conformed by fifty-two of them. The studied variables were: age groups, sex, skin color, general personal pathological antecedents, ocular personal pathological antecedents, symptoms, signs and visual acuity and treatment variants in each patient. Results: A total of fifty-two patients with neovascular glaucoma were found. The age group of more than 60 years, the masculine sex and the white race prevailed. Diabetes mellitus as general personal pathological antecedent and diabetic retinopathy as ocular pathological antecedent predominated. Conclusions: The neovascular glaucoma occupies an important place in ophthalmology, if it is take into account its ocular fatal consequences; the description of its characteristics is exposed.

Uso de la triamcinolona subtenoniana en pacientes con rubeosis del iris / Use of intravitreal triamcinolone in patients with iris rubeosis

Describir el comportamiento de la rubeosis del iris luego de la aplicación de triamcinolona subtenoniana. Se realizó un estudio descriptivo de corte longitudinal con 25 pacientes para un total de 32 ojos con diferentes afecciones oculares. Se efectuaron pruebas estadísticas con las variables del estudio y en algunas se utilizó la prueba de los signos de comparación para datos pareados y en otras se aplicó chi cuadrado. Se caracterizaron las variables: edad, sexo, causa de rubeosis del iris y sus estadios, síntomas y tratamiento con láser de panfotocoagulación retiniana. La retinopatía diabética proliferativa fue la afección más frecuente en el 76 por ciento de los pacientes, seguida de la oclusión de la vena central retiniana. Del total de pacientes tratados, el 37,5 por ciento evolucionó satisfactoriamente el estado de la rubeosis del iris. Fue mayor el número de pacientes que mejoraron el grado de la rubeosis con tratamiento combinado de láser y triamcinolona subtenoniana, aunque estadísticamente no fue significativo. El estado de la rubeosis mejoró en más de la mitad de los pacientes con tiempo de evolución menor de 6 meses. En aquellos con un tiempo mayor de 6 meses y neovascularización del iris grado III, se pudo estabilizar el glaucoma neovascular. Se plantea que la triamcinolona subtenoniana constituye una alternativa para el manejo de este tipo de pacientes.

To describe the behaviour of iris rubeosis after using intravitreal triamcinolone. A longitudinal descriptive study was performed on 25 patients for a total number of 32 eyes with several ocular diseases. Statistical tests were made with the study variables; sign comparison for paired data and Chi square tests were applied. The variables were age, sex, cause of iris rubeosis and its staging, symptoms and treatment with retinal photocoagulation laser. Proliferative diabetic retinopathy was the most common disease in 76 percent of patients, followed by central retinal vein occlusion. Of the total number of treated patients, 37,5 percent had satisfactory recovery in terms of the iris rubeosis condition. The number of patients that improved rubeosis condition after a combined therapy of laser and intravitreal triamcinolone was higher but not statistically significant. Rubeosis condition improved in over 50 percent of patients whose rubeosis had developed in less than six months. However, in those patients with the disease affecting them for more than 6 months and third grade iris neovascularization, neovascular glaucoma could be stabilized. Intravitreal triamcinolone is an alternative for the management of this type of patients.

Intracameral bevacizumab for treatment of iris rubeosis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:.To report the curative effect and safty of intracameral bevacizumab(avastin)in patients with rubeosis iridis.METHODS:5 cases(5 eyes)with iris rubeosis secondary to diabetic retinopathy,retinal periphlebitis(Eales disease)and branch/central retinal vein occlusion,among which 2 cases were silicon oil eyes and were performed intracameral bevacizumab(avastin)0.03 cc(0.75mg),one case is combined with trabeculectomy.and another with cyclocryosurgery.RESULTS:The rubeosis of all cases disappeared quickly,meanwhile the intraocular pressure decreased to normal range with the help of anti-glaucoma operation and medicine.There are not any sign of rubeosis again in the 2-5 months follow-up visits and intraocular pressure were well-controlled.CONCLUSION:Intracameral bevacizumab(avastin)was an effective treatment for rubeosis,esp,for some cases that can not be injected to vitreous cavity.Short term study of intracameral bevacizumab demonstrated rapid regression of rubeosis and well-tolerated injection with no obvious side effects.

Alteration of intraocular pigment epithelium-derived factor and vascular endothelial growth factor in patients with diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the aqueous, vitreous, serum levels of pigment epithelium-derived factor (PEDF)and vascular endothelial growth factor(VEGF)in patients with proliferative diabetic retinopathy(PDR), and to speculate on the source of the change in concentration and to discuss its clinical significance.METHODS:Forty-one eyes withproliferative diabetic retinopathy were included in the study, 16 of which were complicated by neovascularization of iris (NVI).Twenty-one eyes with idiopathic macular hole (MH)were as controls. The aqueous, vitreous, serum levels of PEDF and VEGF of all the groups were determined with ELISA. PEDF, VEGF and the levels in the three groups were compared with analysis of variance (ANOVA). The PEDF, VEGF concentrations in aqueous,vitreous and serum were analyzed with Pearson correlation test,and the correlation of PEDF and VEGF levels was also analyzed with Pearson correlation test.RESULTS:The aqueous levels of PEDF decreased significantly in sequence in groups of control, PDR without NVI, PDR with NVI. VEGF levels increased coordinately. The similar findings existed in vitreous samples. The PEDF,VEGF levels in aqueous were not correlated significantly with those in serum,but correlated positively with those in vitreous. The intraocular levels of PEDF had a negative correlation to those of VEGF.CONCLUSION:The reduction of intraocular PEDF level and elevation of intraocular VEGF level may play an important role in the occurrence and progression of PDR. In the development of PDR, the PEDF,VEGF levels in aqueous may be mainly effected by local pathological changes, as anti-angiogenic and pro-angiogenic factors, their unbalanced intraocular distribution may promote the angiogenesis of the iris and retina.

A Case of Neovascular Glaucoma in Radiation Retinopathy

PURPOSE: To report a case in which radiotherapy damaged the microvasculatures of the retinal vessels and developed cotton-wool patches and retinal hemorrage as well as rubeosis iridis and intractable neovascular glaucoma. METHODS: A 64-year-old female presented with visual loss in her left eye two years after radiotherapy for malignant melanoma of the nasal cavity. The visual acuity of her left eye was counting fingers. Although any specific signs were not shown in the cornea or lens, multiple cotton-wool patches and retinal hemorrhages were noted around the optic disc. RESULTS: Multiple cotton-wool patches and retinal hemorrhages disappeared gradually. Finally, rubeosis iridis and intractable neovascular glaucoma developed which could not be controlled by panretinal photocoagulation. CONCLUSIONS: Radiotherapy for malignancy of the nasal cavity was associated with intractable neovascular glaucoma.

Causes of Decreased Visual Acuity after Vitrectomy for Diabetic Retinopathy

We investigated the poor prognostic factors for trans pars plana vitrectomy in the complicated cases of proliferative diabetic retinopathy. A total of 150 eyes in 125 patients with complications of diabetic retinopathy were treated surgically. The postoperative visual acuity was decreased according to Snellen E chart compared to the preoperative in 53 eyes out of 150 eyes. The cases with poor visual outcomes are as follows; 4 cases with rubeosis iridis, 12 of 14 cases with retinal detachment involving three qua tors of the retina including the fovea, 6 cases with increased IOP(>21 mmHg) and 23 of 30 cases with chronic renal failure.

A Case of Ocular Ischemic Syndrome

Ocular ischemic syndrome, characterized by rubeosis iridis, anterior uveitis, retinal arterial narrowing, retinal hemorrhage, cherry red spot, and neovascularization of the disc and/ or retina, is due to anterior and posterior segment ischemia caused by carotid artery obstruction. A 67-year-old man presented a typical ocular ishemic syndrome. The patient complained marked visual disturbance of the both eyes and headache for 15 days. On slit-lamp examination, there were no abnormal findings of the cornea, iris, and lens. Funduscopic finding revealed bilateral edema of the optic disc, marked attenuation of the arteriole with focal constriction, and dilatation of the veins. Fluorescein angiography showed prolonged arm-to-retinal circulation and retinal arteriovenous transit time, multiple microaneurysms, and staining retinal vessels of the both eyes. About 1+1/2 months later, iritis, rubeosis iridis, and cataract of both eyes were noticed. In carotid angiogram the left internal carotid artery was completely occluded, and the right internal carotid artery was incompletely occluded. About 7 months later, he died of CVA.

Ultrastructure and blood-iris barrier in experimental rubeosis iridis in rabbit

Iris neovascularization was produced in rabbits by hypotony following repeated aspiration of the vitreous. The hypotony was produced after 0.3 ml of vitreous fluid was aspirated using a 25-gauge needle through the pars plana of 10 rabbits. For the histochemical study, horseradish peroxidase(HRP) was injected through the ear lobe vein. After fixation of the iris tissue, the tissue was treated with diaminobenzidine and examined with both light microscopy and transmission electron microscopy. The newly-formed vessel was abundant, particularly on the upper stroma of the iris. The new vessel formation was evident due to the proliferation of endothelial cells, which may have been derived from preexisting iris vessels. The endothelial cells of the newly-formed vessels revealed prominent villous processes into the vascular lumen, formation of the marginal flap, numerous fenestrations in the endothelial junction, and reaction product onto extravascular space by the cytochemical electron microscopy. These results suggest that hypotony in the rabbit produces the disruption of the blood-iris barrier and the balance between angiogenesis-antiangiogenesis modulation.