A 54-year-old man with known proliferative diabetic retinopathy is noted on slit lamp examination to have fine new vessels at the pupillary margin. Intraocular pressure is 16 mmHg, gonioscopy shows an open angle with no angle vessels, and the media are clear. What is the most appropriate next step?

• A Cyclocryotherapy to the ciliary body
• B Peripheral laser iridotomy
• C Observation with review in 3 months
• D Prompt panretinal photocoagulation ✓

Explanation

Anterior segment neovascularization with a normal pressure and open angle represents pre-glaucomatous rubeosis iridis. The definitive treatment is ablation of ischemic retina with prompt panretinal photocoagulation, often supplemented by an anti-VEGF injection for rapid regression. Waiting allows progression to angle closure, while cyclocryotherapy is reserved for refractory cases with uncontrolled neovascular glaucoma and poor visual potential. Iridotomy treats pupillary block, not neovascularization.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.