Rubeosis iridis is a common complication of diabetic retinopathy and is caused by reduced blood flow. Patients suffer from vascular proliferation in the area of the iris and the anterior chamber angle, which can be associated with bleeding. In addition to causal treatment of the underlying disease, patients are treated in the form of symptomatic glaucoma therapy.
What is rubeosis iridis?
Proliferations correspond to rapid growth or multiplication processes in body tissue, which are tantamount to overgrowth. The basis of every profile is accelerated cell division, as it characterizes the healing phase of wound healing. Cell proliferation is subject to the control of a wide variety of factors. For bacterial infection definition, please visit electronicsmatter.com.
Hormones such as somatotropin are just as relevant as growth-promoting proteins. Tissue areas with increased proliferation processes are referred to in histology as proliferation zones. Different diseases are characterized by symptomatic proliferation. One such condition is rubeosis iridis.
This is a complication of various eye diseases. Characteristically, the proliferation in patients with rubeosis iridis affects the blood vessels of the iris. The vessels of the eye chamber angle can also be affected by the increased division processes.
The causative framework for rubeosis iridis is an oxygen deficiency. The lack of oxygen affects the tissue of the retina and can be the result of various primary diseases. One of the most common underlying diseases in this context is diabetes.
This metabolic disease can manifest itself in diabetic retinopathy, which is associated with reduced blood flow in the retina. Such reduced blood circulation is always to be equated with an undersupply of oxygen, since the blood in the human organism acts as a transport medium for nutrients and oxygen.
An undersupply of the retina occurs not only in diabetic retinopathy, but also after a central vein occlusion. The organism reacts to the lack of oxygen by releasing vasoproliferative factors. The vascular endothelium growth factor is particularly relevant in this context: This growth factor initiates vasoproliferation.
These factors reach the anterior segment of the eye via the aqueous humor and thus have direct contact with the chamber angle and the iris. In these structures, the factors trigger the formation of new blood vessels, which is intended to prevent the previous reduced blood flow.
Symptoms, Ailments & Signs
Patients with rubeosis iridis primarily suffer from reduced blood flow or other oxygen undersupply in the area of the iris and the chamber angle. This phenomenon triggers the formation of new blood vessels. The tissue begins to proliferate in the iris and chamber angle area and shows up in the histology as a proliferation zone.
In most cases, the increased cell division in the tissue of the vessels does not go unnoticed. Severe vasoproliferation often results in vascular damage that is accompanied by visible bleeding. After rupture of the newly formed vessels, the bleeding increases the risk of an aqueous humor outflow blockage.
If the aqueous humor can no longer drain sufficiently from the eye due to bleeding, the intraocular pressure increases. The further the pressure increases, the more likely it is that glaucoma will develop as a consequence.
This type of glaucoma is what is known as open-angle glaucoma, which is secondary to proliferation. Since the proliferation itself is merely the symptom of a higher-level disease, both phenomena are secondary disease processes.
Diagnosis & course of disease
The suspected diagnosis of rubeosis iridis can be made purely by looking at it. The doctor develops this suspicion above all in the case of accompanying vascular ruptures and bleeding. If the connection with a primary disease can be established in the anamnesis, the first suspected diagnosis is confirmed.
A tissue sample from the proliferation zone can help rule out malignant division processes. An intraocular pressure measurement is absolutely necessary as part of the diagnosis in order to be able to assess the possible risk of glaucoma.
In many cases, those affected do not go to the ophthalmologist for a long time because they do not suspect any danger behind the symptoms. For this reason, the diagnosis is made relatively late in many cases. In principle, the prognosis for patients with rubeosis iridis depends on the primary causative disease and the time of diagnosis.
Severe vasoproliferation often results in damage to the vessels in the eye, combined with visible bleeding and the risk of a so-called aqueous outflow blockage. If the bleeding blocks the outflow of aqueous humor, this can lead to an increase in intraocular pressure. High eye pressure, in turn, promotes the development of glaucoma.
Visual disturbances cannot be ruled out either. When treating rubeosis iridis, the main risks come from the medication prescribed. Since the eye disease is usually based on diabetes, preparations that strongly interfere with the body’s own processes are mainly used. During insulin therapy, edema or water retention can occasionally form in the body.
The patient sometimes also suffers from weight gain and visual disturbances. Disorders in the subcutaneous fatty tissue can occur as a result of injecting insulin. Occasionally, skin irritation occurs at the puncture site, which is expressed in the form of reddening, itching, swelling and wheals. Rarely, vasoproliferation itself is treated surgically. Surgery carries the risk of injury and infection, but it can also lead to serious complications such as blurred vision or permanent vision loss.
When should you go to the doctor?
Rubeosis iridis should always be treated by a doctor. This disease cannot heal itself, so the affected person always needs treatment from a doctor to prevent further complications. The doctor should be consulted if there is new formation of blood vessels in the iris in the area of the eyes. The eyes can appear very red or very tired, so that a doctor should be consulted at these first signs.
The blood circulation is also increased, so that there are burst veins in the eye, which are relatively easy to recognize. Outsiders can also point out the symptoms of rubeosis iridis to those affected. If rubeosis iridis is not treated, glaucoma can also develop, which must also be treated. Rubeosis iridis is treated by an ophthalmologist. There are no particular complications and the disease can usually be treated relatively well.
Treatment & Therapy
In everyday clinical practice, treating physicians distinguish between causal and symptomatic treatment approaches. Although symptomatic treatments reduce the individual symptoms, they do not affect the actual cause of a disease. Causal therapies resolve the cause as far as possible and in this way eliminate all existing symptoms at the same time.
The distinction between causal and symptomatic therapeutic approaches also plays an important role for patients with rubeosis iridis. In the foreground of the therapy is the causal treatment of the underlying disease with vascular profiling in the area of the iris and the chamber angle.
With this causal therapy, the cause of the triggering oxygen deficiency should be resolved in order to rule out repeated or progressive ischemia. If the disease process has already resulted in an emerging secondary glaucoma, this glaucoma must be treated symptomatically.
This symptomatic treatment corresponds to an anti-glaucomatous therapy. The use of VEGF-binding antibodies for the therapy of Rubeosis iridis is now being discussed. Antibodies of this type are, for example, bevacizumab. Presumably, treatment with these agents could prevent, or at least inhibit, vasoproliferation.
Rubeosis iridis can only be prevented to the extent that the causes of the phenomenon can be prevented. Since diabetes mellitus is one of the most common causes of retinopathies and because these retinopathies result in rubeosis iridis in many cases, the prevention of vascular profiling is broadly based on the preventive measures for diabetes. In addition to a healthy diet, this includes, for example, sufficient exercise.
The reddish cloudiness of the iris gives Rubeosis iridis its name. New blood vessels are formed in the eye, and they continue to expand. Rubeosis can have different causes. In many cases, there are already existing abnormalities in the eye vessels or diabetic diseases. In some patients, rubeosis was preceded by an inflammatory process. Follow-up care is advisable to avoid consequential damage to the eye. The goals of follow-up therapy are to eliminate the cause and contain excessive vascular formation.
The treatment is carried out under the supervision of an ophthalmologist. A differential diagnosis must be made beforehand. The prognosis depends on the extent of the disease. An acute form is easier to treat, while the probability of a full recovery is poorer in the chronic course. In this case, damage often remains in the eye. Treatment must start as early as possible.
According to the current state of research, the formation of new vessels cannot be contained by administering medication. The specialist must treat the causative disease. In severe cases, surgery is the last option. Part of the aftercare takes place here in the eye clinic. The surgeon checks the wound healing as well as the patient’s postoperative condition. The aftercare does not end with the discharge, but is continued with regular ophthalmological follow-up checks.
You can do that yourself
The cause of the disease can often be traced back to reduced blood flow. For this reason, sufferers can take various measures to stimulate blood circulation.
Sports activities, targeted training of the joints and exercises to stimulate the circulation should be applied throughout the day. It is important to ensure that you are not overwhelmed or overexerted. The exercises can be integrated into everyday life without much effort and can therefore be used at any time. We recommend consulting and working with a physiotherapist to ensure that there is no incorrect loading or excessive strain on the body.
In addition, the patient should avoid environments where the quality of the air is very poor. Smoking rooms should therefore be avoided. Regular airing of the premises and spending time outdoors promotes the body’s oxygen intake and improves well-being. If visual disturbances occur, everyday life must be adjusted and restructured according to the patient’s possibilities. Frequently, changes have to be made in the fulfillment of daily duties in order to minimize the risk of accidents.
Relaxation techniques and cognitive training have proven their worth in order to be able to deal better mentally with the disease . These can be carried out on your own on a daily basis. In addition, they are characterized by a strengthening of the quality of life, as they build up and promote mental strength.