Iris Neovascularization: An Enigma to Be Solved

A 70-year-old diabetic patient with a history of cataract surgery and a diminution of vision in the right eye (RE) was found to have an intraocular pressure (IOP) of 54 mmHg with microcystic corneal edema. After lowering of IOP with medications, he was examined and found to have RE iris neovascularization and evidence of eventful cataract surgery, cortical and nuclear matter dropped in the vitreous cavity, and both eyes had mild to moderate diabetic retinopathy. The neovascularization was presumed to be inflammatory owing to mild to moderate retinopathy findings a normal carotid doppler. The patient underwent pars plana removal of the nucleus and cortical matter. The neovascularization, however, recurred 2 weeks post-surgery with continued high IOP, and angiography at this time revealed extensive ischemic areas in the retina with intraretinal microvascular abnormalities. Keeping the uncontrolled IOP in mind, the patient was planned for a posterior Ahmed glaucoma valve surgery combined with endo-photocoagulation which resulted in a well-lasered retina with a stable visual acuity and IOP. Significant inflammation in such eyes with diabetic retinopathy may lead to an exacerbation of the retinopathy with extensive ischemia and its sequelae and pose a challenge in management due to the multifactorial etiology.