A diabetic patient is noted to have neovascularisation of the iris (rubeosis iridis) on slit-lamp examination. The vessels begin at the pupillary margin and extend toward the angle. What is the greatest immediate risk if untreated?
- A Hyphema from spontaneous rupture of iris new vessels
- B Uveitis from VEGF-mediated breakdown of blood-ocular barrier
- C Neovascular glaucoma (NVG) from angle closure by fibrovascular membrane ✓
- D Central retinal artery occlusion from increased IOP
Explanation
Rubeosis iridis (iris neovascularisation) is driven by VEGF released from ischaemic retina. The new vessels grow from the pupillary margin across the iris surface and into the drainage angle, where they form a fibrovascular membrane that contracts, closing the angle and causing neovascular glaucoma — a refractory, painful form of glaucoma with very high IOP (often >50 mmHg) and a poor prognosis. The immediate treatment priority is panretinal photocoagulation to destroy the ischaemic retina and reduce VEGF drive, plus intravitreal anti-VEGF to rapidly regress the neovascularisation. Spontaneous hyphema can occur but is a secondary risk. Uveitis and CRAO are not the primary immediate threats from rubeosis iridis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.