Rubeosis Iridis Research Articles

Complications and Management of Post-vitrectomy Circumferential Retinal Detachment

Four consecutive patients with chronic peripheral circumferential detachment developed vision-threatening complications requiring further treatment. All four cases had more than one previous vitreoretinal surgery; two cases had silicone oil intravitreally and three had crystalline lens removed. The main complications included chronic hypotony (1 case), rubeosis iridis (4 cases), intraocular hemorrhage (1 case), neovascular glaucoma (1 case), and cataract (1 case). Retinectomy with peripheral traction release and silicone oil infusion resulted in improvement or stabilization of visual function in all four cases.

Case study: Rubeosis iridis in a newborn with diabetic fethopathy

Introduction: The diabetic pregnancy is unique with a diversity of organ systems affected in the fetus. Infants of diabetic mothers present with an increased risk of morbiditiy and mortality related to congenital malformation and/or diabetic fetopathy including macrosomia, hypertrophic cardiomyopathy, respiratory compromise and hypoglycemia. In contrast to adults, ophthalmologic pathologies are not described.

Anti-angiogenic Drugs as an Adjunctive Therapy in the Surgical Treatment of Diabetic Retinopathy

Anti-VEGF drugs may be employed in the surgical treatment of diabetic retinopathy: 1. Prior to surgery. The intravitreal injection of anti-VEGF drugs leads to a significant reduction of neovascularization, with a reduction in the adherence of the fibrovascular complex to the retina. This simplifies viscodelamination and reduces intraoperative bleeding during delamination and segmentation. To minimize the risk of tractional retinal detachment due to the contraction of fibrovascular tissue, vitrectomy must be performed within one week after the injection. 2. To decrease the risk of postoperative bleeding. Recurrent vitreous hemorrhages after vitrectomy are often due to small bleeding from persistent neovascularization. The injection of anti-VEGF drugs at the end of vitrectomy could prevent bleeding from these vessels by blocking the pro-inflammatory stimulus of the surgical procedure. 3. To treat postoperative vitreous hemorrhage. The intravitreal injection of anti-VEGF drugs in patients with postoperative bleeding leads to resolution of the hemorrhage. 4. To treat rubeosis iridis. In eyes with complete panretinal photocoagulation, the combination of cryotherapy and intravitreal anti-VEGF injection in the same surgical procedure produces a disappearance of iris neovascularization together with a long term effect with no recurrences. In neovascular glaucoma, anti-VEGF drugs can also facilitate filtrating surgery.

Preliminary access of efficacy of vitreoretinal surgeries without endotamponade for diabetic tractional retinal detachment

Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD).Methods The clinical interventional case series study included 104 patients (112 eyes) with DTRD,who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas.Among the eyes,there were 6 eyes with iris neovascularization (INV),1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment.There were no pre-existing retinal holes or breaks prior to surgery nor any iatrogenie retinal breaks developed during vitrectomy.Cataract removal combined with intraoeular lens implant surgeries were performed on 15 eyes.Follow-up duration varied from 12 to 65 months (mean: 29 months).Results Subretinal fluid was completely absorbed within 2 months after surgery.In 107 eyes (95.54%),the retina reattached after surgery and remained attached till the end of follow-up period.Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%),remained unchanged in 14 eyes (12.500%) and got worse in 19 eyes (16.79%).The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes,66.00% Vs 46 eyes/62 eyes,74.19%,χ2=0.89,P=0.344).No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries.Seven (6.25%) eyes showed INV (5 new onset eyes),and none of them developed into NVG.In multivariate logistic regression,factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis I-adjusted odds ratio (OR)= 10.2],low preoperative BCVA (OR= 11.1) and low postoperative BCVA (OR = 16.7).Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oil or gas tamponade if there are no preoperative or intraoperative retinal breaks,and only using irrigation fluid could access a good long-term prognosis result. Key words: Diabetic retinopathy/surgery; Retinal detachment/surgery; Vitrectomy; Silicone oils/therapeutic use; Noble gases/therapeutic use

Intravitreal bevacizumab (avastin) as an adjuvant treatment in cases of neovascular glaucoma

Purpose:To evaluate the effect of intravitreal bevacizumab (avastin) injection in cases of neovascular glaucoma.Study Design:Clinical case series.Materials and Methods:Sixteen eyes of 16 patients with rubeosis iridis and secondary glaucoma were administered intravitreal injection of bevacizumab (2.5 mg). The patients were followed for 2 months.Results:We noted partial or complete regression of iris neovascularization 1 week after injection of bevacizumab. Reproliferation of new vessels was detected in 25% of the cases after 2 months. The mean intraocular pressure (IOP) before injection was 28± 9.3 mm Hg under topical ß-blocker and systemic acetazolamide. One week after injection, the IOP decreased to 21.7± 11.5 mm Hg (5 cases without anti-glaucoma drugs, 6 cases with topical ß-blocker and 5 cases with both topical ß-blocker and systemic acetazolamide).Conclusion:Intravitreal bevacizumab (avastin) injection leads to regression of iris neovascularization with subsequent drop of IOP in eyes with neovascular glaucoma.

Penetration of Bevacizumab into the Iris, Anterior Chamber Angle and Ciliary Body After Intravitreal Injection

Recently, it was suggested that the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab could be used in the treatment of rubeosis iridis. Therefore, we aimed to trace the penetration of bevacizumab into the anterior chamber after intravitreal injection of the drug. We found that intravitreally injected bevacizumab penetrates well and quickly into the anterior chamber angle, iris and ciliary body. The highest concentration of bevacizumab is present on days one to four after injection, with penetration into the iris appearing to be faster than that into the anterior chamber angle and ciliary body. These findings are consistent with the clinically described regression of iris neovascularisation one to three days after injection. Furthermore, we demonstrated progressive penetration through the tissues of the anterior chamber towards the sclera. Our study showed that the intravitreal application mode is suitable for obtaining an accumulation of bevacizumab throughout the vascularised tissues of the anterior segment. Intravitreal bevacizumab may be used as a supplementary treatment for rubeosis iridis and neovascular glaucoma.

Juvenile diabetes eye complications and treatment

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. The aim of this study was to explore the prognosis of patients with juvenile DM regarding diabetic eye complications, as well as the course of the diabetic eye disease related to the treatment undertaken. The study series involved 33 patients with juvenile DM during the period 1992-2007. The influence of the following factors on the course of the disease was estimated: age, the age of the disease onset, time when eye complications appeared, treatment modalities. Of the total of 33 diabetics 15 patients were followed for 10 or more years and 18 from 5 to 9 years. At the time of their first visit the mean age was 23.12 +/- 6.39 and the mean duration of DM was 17.42 +/- 7.42 years. On their first visit, 7 eyes were without any complication. Most of the patients already developed clinical signs of proliferative diabetic retinopathy (41.39%), the signs of nonproliferative diabetic retinopathy (13.13%) and macula involvement (10.10%). Diabetic cataract was found in 8.8% as well as tractional retinal detachment. Eleven out of 66 eyes were with vitreous hemorrhage. Two patients (5.5%) suffered neovascular glaucoma. There was 1 (2.2%) patient with developed rubeosis iridis and simplex glaucoma. Panretinal photocoagulation was performed in 65% of patients, focal photocoagulation in 15%, 12% patients underwent pars plana vitrectomy and 4% had cataract surgery with intraocular lens implantation and peripheral retinal kryopexy. Total vision loss due to eye complications of juvenile DM may be prevented if timely diagnosed with regular check ups and early treatment.

Rubeosis Iridis Resulting from Agenesis of the Internal Carotid Artery: A Case Report~!2008-10-14~!2008-11-28~!2008-12-05~!

We report a case of rubeosis iridis resulting from agenesis of the internal carotid artery. Agenesis of the internal carotid artery is a rare congenital anomaly, and most patients do remain asymptomatic, but we should realize that this condition may lead to ocular ischemic changes, the result being rubeosis iridis.

Shall we use Avastin® or Lucentis® for ocular neovascularization?

Shall we use Avastin^® or Lucentis^® for ocular neovascularization?

Intravitreal bevacizumab in recurrent diabetic vitreous haemorrhage after vitrectomy

Editor, R ecurrent vitreous haemorrhage (VH) is the most frequent complication of vitrectomy to treat proliferative diabetic retinopathy (PDR), affecting up to 75% of cases (Schachat et al. 1983). Several questions on the subject remain unanswered, such as how long we should wait before performing a new surgery, whether the patient needs to be positioned and which other therapies could be used. The most frequently used treatment for this condition is to repeat vitrectomy if adequate time and positioning have failed, with an average number of 2.3 vitrectomies (Cooper et al. 2004). Bevacizumab is a recombinant monoclonal antibody directed against vascular endothelial growth factor (VEGF) for cancer therapy that has been used to treat PDR (Spaide & Fisher 2006) among other vascular retinal diseases. In order to avoid repeated vitrectomies, we have performed intravitreal injection of bevacizumab (IVB) to treat recurrent post-vitrectomy diabetic VH. Four eyes from four patients with recurrent VH after vitrectomy to treat PDR were treated by monthly IVB injections of 1.25 mg bevacizumab. All these patients had undergone pars plana vitrectomy with detachment of posterior hyaloid and removal of vitreoretinal adherences. Panretinal photocoagulation had been performed during surgery in all cases. Following vitrectomy, the patients had presented two or more cases of recurrent VH that had not cleared after two further vitrectomies and more than 2 months of follow-up. Retina was attached, as confirmed by B-scan prior to IVB injection. The patients are described in Table 1. Treatment was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki, and data gathering was performed after obtaining written informed consent. Patients were informed about the off-label situation of this therapy. Best-corrected visual acuity (BCVA) was determined at 4 months using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts (Lighthouse, New York, USA) by certified optometrists. VH density was graded as previously described (Kuppermann et al. 2005). BCVA, indirect funduscopy and ultrasound B-scan were performed at the first visit and then monthly during follow-up. The patients were asked about the appearance of adverse events. All the cases had a grade 3 VH with BCVA hand motion at baseline. No changes in VH could be observed after one single IVB injection. VH cleared completely after two IVB injections in cases 2 and 3, reaching BCVA 20 ⁄400 and 20 ⁄ 125 respectively. VH density was grade 2 after two injections in cases 1 and 4; VH cleared completely after three IVB injections, with final BCVA 20 ⁄ 32 and 20 ⁄ 400 respectively (Table 1). Two patients presented rubeosis iridis, which disappeared after treatment by IVB. No changes in intraocular pressure, inflammatory reaction or other adverse events were observed. Recurrent VH has been attributed to persistence of vitreoretinal neovascularization (Sawa et al. 1998). IVB may induce temporary regression of retinal neovascularization and cessation of bleeding, which may allow spontaneous resorption and clearance of VH. IVB is a less invasive therapeutic alternative in cases of postvitrectomy recurrent VH that does not imply the need for further surgery. In view of the good results achieved (complete clearance in all cases), we may consider IVB as a therapeutic alternative for these patients. Randomized, controlled prospective studies including other possible therapeutic possibilities will probably establish the optimal treatment for these cases.

Adjuvante zirkuläre Netzhautkryokoagulation bei proliferativer diabetischer Vitreoretinopathie - vor oder während der Vitrektomie?

It is unclear if a circumferential cryocoagulation 4 weeks before pars plana vitrectomy is useful for reducing the risks of surgery such as retinal detachment, secondary glaucomas or rebleeding. Otherwise it seems possible that this surgery itself, done in local anaesthesia, could be an additional risk. We retrospectively evaluated the reports of all patients who underwent vitrectomy as primary surgery due to proliferative diabetic vitreoretinopathy between 1997 and 2000. Besides age and sex, all additional surgery (like phacoemulsification, endolaser coagulation, kind of tamponade etc.) and all intra- or postoperative complications were reported after a follow-up of at least 3 months. We created and compared 2 groups of patients, showing in group 1 patients who underwent vitrectomy 4 weeks after cryocoagulation and in group 2 patients undergoing vitrectomy combined with circumferential cryocoagulation. We evaluated the reports of 226 patients (103 men, 123 women, mean age 58.6 +/- 13.0 years). Follow-up was in the mean 16.3 months. Group 1 contained 150 patients (66.4 %), group 2 76 patients (33.6 %). 63.7 % received air as endotamponade, 8.0 % C(2)F(6) gas, 7.1 % silicon oil and 21.2 % BSS, 34.1 % were operated in combination with phakoemulsification. We observed 9 postoperative retinal detachments (4.0 %), with no significant difference between the two groups (6 detachments in group 1, 2 detachments in group 2). For other surgical risks like rebleeding, rubeosis iridis, secondary glaucoma etc. we also found no statistically significant differences. Circumferential retinal cryocoagulation is a useful preparation before pars plana vitrectomy, when done due to vitreous haemorrhage, because improved resorption lowers the vitrectomy rate. In all other cases it can be done during vitrectomy. Adjuvant circumferential cryocoagulation seems to decrease the risk of postoperative retinal detachments and rebleedings as documented in literature comparison.

Long-Term Outcomes of Heavy Silicone Oil Tamponade for Complicated Retinal Detachment

To assess the long-term success rates and complications of heavy silicone oil tamponade (Oxane HD) in the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR). Twenty-one eyes of 21 patients with complicated retinal detachment and PVR were included in this study. Vitreoretinal surgery with heavy silicone oil (Oxane HD) tamponade was performed in all patients. Heavy silicone oil was injected by perfluorocarbon liquid-air-silicone oil exchange, and was removed after 3 months. The main outcomes of the surgery including the success and complication rates were evaluated during the mean follow-up period of 11.4+/-0.88 months. Wilcoxon signed ranks test was used for statistical analysis of visual acuity changes. The outcomes of our study were compared with those of the previous studies. All eyes had complicated retinal detachment with PVR Grade C3 or worse. Retinal detachment was rhegmatogenous in 6 eyes, secondary to previous detachment surgery in 11 eyes, secondary to proliferative diabetic retinopathy in 3 eyes, and secondary to perforating eye injury in 1 eye. The overall anatomic success rate was 80.9% at the end of the follow-up period. The overall visual success rate was 42.8%, with no statistically significant difference from baseline (p>0.05). Postoperative complications included severe reproliferation (4 eyes), intraocular pressure rise (3 eyes), anterior dislocation of silicone oil (2 eyes), posterior subcapsular cataract formation (4 eyes), vitreous hemorrhage (1 eye), rubeosis iridis (3 eyes), optic atrophy (1 eye), and ocular pain and photophobia (21 eyes). According to the results of this study, vitreoretinal surgery with temporary heavy silicone oil tamponade appears to increase the anatomic success rates with minimal complication rate in cases with complicated retinal detachment and PVR.

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.

Ocular Diseases in HIV/AIDS

This study evaluated the prevalence of HIV seropositivity among a suspected group and describes the ocular manifestations among patients seen at the eye clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Confirmatory diagnosis of HIV/AIDS by serologic tests was positive in 11 (28.9%) patients. Age range of 11 HIV/AIDS positive patients was 16 to 56 years, with a mean age of 32 +/- 2.7 years. There were 7 males and 4 females, giving a male to female ratio of 1.8:1. Of the 11 indexed patients, 1 had squamous cell carcinoma of the conjunctiva related to acquired Immunodeficiency Syndrome; four [36.4%] had herpes zoster ophthalmicus (3 males and I female) and herpes simplex keratitis (1).Others were lateral rectus muscle palsy and associated optic atrophy(1), uveitis(2), uniocular pan-uveitis with rubeosis iridis(1) and retinopathy (2). This study showed a significant proportion of patients suspected of HIV/AIDS among high risk patients were actually infected. A high index of suspicion is required in diagnosing HIV/AIDS among ophthalmic patients. Keywords : This study evaluated the prevalence of HIV seropositivity among a suspected group and describes the ocular manifestations among patients seen at the eye clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Confirmatory diagnosis of HIV/AIDS by serologic tests was positive in 11 (28.9%) patients. Age range of 11 HIV/AIDS positive patients was 16 to 56 years, with a mean age of 32 +/- 2.7 years. There were 7 males and 4 females, giving a male to female ratio of 1.8:1. Of the 11 indexed patients, 1 had squamous cell carcinoma of the conjunctiva related to acquired Immunodeficiency Syndrome; four [36.4%] had herpes zoster ophthalmicus (3 males and I female) and herpes simplex keratitis (1).Others were lateral rectus muscle palsy and associated optic atrophy(1), uveitis(2), uniocular pan-uveitis with rubeosis iridis(1) and retinopathy (2). This study showed a significant proportion of patients suspected of HIV/AIDS among high risk patients were actually infected. A high index of suspicion is required in diagnosing HIV/AIDS among ophthalmic patients. This study evaluated the prevalence of HIV seropositivity among a suspected group and describes the ocular manifestations among patients seen at the eye clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Confirmatory diagnosis of HIV/AIDS by serologic tests was positive in 11 (28.9%) patients. Age range of 11 HIV/AIDS positive patients was 16 to 56 years, with a mean age of 32 +/- 2.7 years. There were 7 males and 4 females, giving a male to female ratio of 1.8:1. Of the 11 indexed patients, 1 had squamous cell carcinoma of the conjunctiva related to acquired Immunodeficiency Syndrome; four [36.4%] had herpes zoster ophthalmicus (3 males and I female) and herpes simplex keratitis (1).Others were lateral rectus muscle palsy and associated optic atrophy(1), uveitis(2), uniocular pan-uveitis with rubeosis iridis(1) and retinopathy (2). This study showed a significant proportion of patients suspected of HIV/AIDS among high risk patients were actually infected. A high index of suspicion is required in diagnosing HIV/AIDS among ophthalmic patients. This study evaluated the prevalence of HIV seropositivity among a suspected group and describes the ocular manifestations among patients seen at the eye clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Confirmatory diagnosis of HIV/AIDS by serologic tests was positive in 11 (28.9%) patients. Age range of 11 HIV/AIDS positive patients was 16 to 56 years, with a mean age of 32 +/- 2.7 years. There were 7 males and 4 females, giving a male to female ratio of 1.8:1. Of the 11 indexed patients, 1 had squamous cell carcinoma of the conjunctiva related to acquired Immunodeficiency Syndrome; four [36.4%] had herpes zoster ophthalmicus (3 males and I female) and herpes simplex keratitis (1).Others were lateral rectus muscle palsy and associated optic atrophy(1), uveitis(2), uniocular pan-uveitis with rubeosis iridis(1) and retinopathy (2). This study showed a significant proportion of patients suspected of HIV/AIDS among high risk patients were actually infected. A high index of suspicion is required in diagnosing HIV/AIDS among ophthalmic patients. Keywords : Eye, HIV/AIDS, Suspicion Nigerian Journal of Surgical Science Vol. 16 (2) 2006: pp. 47-53

New classification system-based visual outcome in Eales′ disease

A retrospective tertiary care center-based study was undertaken to evaluate the visual outcome in Eales' disease, based on a new classification system, for the first time. One hundred and fifty-nine consecutive cases of Eales' disease were included. All the eyes were staged according to the new classification: Stage 1: periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages; Stage 2a: capillary non-perfusion, 2b: neovascularization elsewhere/of the disc; Stage 3a: fibrovascular proliferation, 3b: vitreous hemorrhage; Stage 4a: traction/combined rhegmatogenous retinal detachment and 4b: rubeosis iridis, neovascular glaucoma, complicated cataract and optic atrophy. Visual acuity was graded as: Grade I 20/20 or better; Grade II 20/30 to 20/40; Grade III 20/60 to 20/120 and Grade IV 20/200 or worse. All the cases were managed by medical therapy, photocoagulation and/or vitreoretinal surgery. Visual acuity was converted into decimal scale, denoting 20/20=1 and 20/800=0.01. Paired t-test / Wilcoxon signed-rank tests were used for statistical analysis. Vitreous hemorrhage was the commonest presenting feature (49.32%). Cases with Stages 1 to 3 and 4a and 4b achieved final visual acuity ranging from 20/15 to 20/40; 20/80 to 20/400 and 20/200 to 20/400, respectively. Statistically significant improvement in visual acuities was observed in all the stages of the disease except Stages 1a and 4b. Significant improvement in visual acuities was observed in the majority of stages of Eales' disease following treatment. This study adds further to the little available evidences of treatment effects in literature and may have effect on patient care and health policy in Eales' disease.

Accessory optical device for the Heidelberg retina angiograph ( HRA classic ) to perform angiography of the vitreous cavity and the anterior eye segment

The Heidelberg retina angiograph (HRA) classic enables fluorescein angiography (FA) and indocyanine green angiography (ICG-A) of the retina and choroid. The goal of this study was to design an accessory device to adapt the HRA classic for application on structures anterior to the retina. The optical device consisted of a cylindrical two-piece plastic frame holding a magnifying lens commonly used with the indirect ophthalmoscope. A 60-diopters lens was inserted in this frame to enable the angiography of the anterior segment. A less strong lens of 30 diopters was used for the visualization of pathologic findings in the vitreous cavity. We designed an easy-to-use and low-cost device to adapt the HRA classic for angiography of the fundus, vitreous cavity and anterior segment in the same session and without delay. FA and ICG-A images of two patients with rubeosis iridis and of one patient with choroidal melanoma are described.

Diabetic Vitrectomy: Influence of Lens Status upon Anatomic and Visual Outcomes

To determine the effect of lens status upon the anatomic and visual results in primary diabetic vitrectomy. Retrospective, comparative, consecutive case series. One hundred two eyes of 85 patients with proliferative diabetic retinopathy and its complications that underwent primary vitrectomy. The eyes that remained phakic after vitrectomy were compared with the eyes that were either aphakic or pseudophakic (nonphakic) postoperatively. Intraoperative and postoperative complications, vitreoretinal reoperation rate, and ultimate anatomic and visual success with at least 6 months' follow-up. Preoperatively, 72 eyes were phakic, and 30 were aphakic (n = 1) or pseudophakic (n = 29). During vitrectomy, 1 eye underwent lensectomy and 12 eyes underwent phacoemulsification with lens implantation. Postoperatively, 59 eyes were phakic and 43 eyes were nonphakic. The vitreoretinal reoperation rate was significantly higher (P = 0.04) for the phakic group (28.8%) than for the nonphakic group (11.6%). Rubeosis iridis developed in 3 phakic eyes and no nonphakic eyes (P = 0.26). Intraoperative complications were similar in the phakic and nonphakic groups (P = 0.40). Postoperative complications such as rhegmatogenous retinal detachment (P = 0.39), nonclearing vitreous hemorrhage (P = 0.07), and anterior chamber complications (P = 0.60) were also similar. Visual acuity improved by at least 0.2 logarithm of the minimum angle of resolution units in 76.2% of the phakic eyes and 86.0% of the nonphakic eyes (P = 0.22). Eyes that were phakic after primary diabetic vitrectomy had a significantly higher subsequent vitreoretinal reoperation rate when compared with nonphakic eyes, suggesting that diabetic eyes are less likely to require additional vitreoretinal surgery if they are rendered nonphakic before or during vitrectomy.

Neovaskularisationsglaukom

Neovascular glaucoma, as a typical secondary glaucoma, is due to ocular or (earlier) systemic diseases. The formation of a fibrovascular membrane on the anterior surface of the iris (rubeosis iridis) and extending into the chamber angle leads to irreversible obliteration of the outflow system, with a corresponding rise in intraocular pressure. The most frequent cause is retinal ischaemia resulting either from vascular occlusion or from diabetic alterations. The differential diagnosis must include acute angle-closure glaucoma and uncontrolled open-angle glaucoma. Treatment is aimed at eliminating the actual cause or at least reducing the risk factors (e.g. by retinal laser coagulation), or consists in cyclodestructive procedures. Medicamentous therapy comprises anti-inflammatory agents (steroids, cycloplegic agents) and substances that reduce the production of aqueous humour (carbonic anhydrase antagonists, beta blockers). In the near future, antiangiogenic medication might be another effective option. For end-stage neovascular glaucoma, the implantation of drainage devices is also discussed.

Exploración del segmento anterior mediante tomografía óptica de coherencia 3

To show the utility of optical coherence tomography (OCT) for studying the anterior segment and to explain its potential advantages as compared to ultrasonic biomicroscopy (UBM). We have described the findings in 5 patients with different pathologies of the anterior segment, all of whom were studied with UBM and OCT-3 adjusted for the anterior segment. There were 2 cases of an acute attack of closed angle glaucoma, 1 case of rubeosis iridis, 1 case of penetrating ocular trauma and 1 case of a primary stromal iris cyst. OCT was found to be as useful as UBM in detecting angle closure in patients affected by an acute attack of glaucoma. In addition, OCT was more comfortable for the patient and faster than UBM in obtaining images, with the exploration mean time using OCT being less than five minutes while that with UBM was over ten minutes. OCT has also been demonstrated to be a safe and valuable non-contact examination in other iris pathologies such as rubeosis iridis, for checking the permeability of iridotomies and even for studying iris masses such as primary stromal iris cysts. In these entities OCT may reach a higher resolution than ultrasonic biomicroscopy. OCT-3, with an adjustable focus, can obtain images from the scleral angle, as well as from other ocular structures like the iris, thus assisting in the diagnosis of numerous pathologies.

Ocular presentations of breast cancer

Breast cancer is the most common malignancy in women, with increasing incidence in Europe and North America. The frequency of involvement of the eye and visual pathways is reported to be as high as 30% in patients with known metastatic disease. In some cases, ophthalmic involvement can be the first sign of metastatic spread. Metastasis occurs via the haematogenous route and predominantly involves the choroid. Metastases to other ocular structures, the orbit and the visual pathways have also been described. Paraneoplastic effects are rare but significant. Different modalities are employed in the treatment of breast cancer and its metastases. These include chemotherapy and radiotherapy. The ocular adverse effects of these have been well described, but recently developed new treatment modalities, such as monoclonal antibodies, may have different side-effects. With the increasing incidence of breast cancer and the advent of new treatment strategies, the complications of the disease and the sequelae of therapy are highly relevant to both oncologists and ophthalmologists.