Peripheral trans-scleral diode laser retinopexy for rubeosis iridis

Purpose: To evaluate the use of peripheral trans-scleral retinal diode pan-retinal photocoagulation in 10 patients with rubeosis iridis associated with dense vitreous haemorrhage, dense cataract and no fundal view. Methods: 5 patients who had undergone previous retinal surgery and who subsequently developed a vitreous haemorrhage and rubeosis iridis and 5 patients who presented with rubeosis iridis and dense cataract were treated with peripheral trans-scleral diode laser retinopexy in a scatter pattern to promote regression of the rubeosis. All eyes were treated with 360 degree trans-scleral retinal diode laser consisting of 3 rows of 4 burns per quadrant (total 12 burns per quadrant) starting 4 mm posterior to the limbus (immediately behind the ciliary body by trans-illumination). Six of the patients had associated glaucoma and were treated with concurrent trans-scleral cyclodiode ciliary body ablation (360 degrees, 40 burns). Results: All eyes treated by this method showed regression of rubeosis. Three eyes had persistently raised intraocular pressure while the other 7 eyes showed no rise in intraocular pressure or normalization of previously elevated intraocular pressure. No eyes developed peripheral retinal detachment, loss of light perception, or hypotony. Conclusions: Peripheral trans-scleral scatter retinal diode photocoagulation is a safe and effective method for treating patients who develop rubeosis iridis with or without increased intraocular pressure. The method is of particular value when the fundus cannot be visualized and other factors preclude further intra-ocular surgical intervention.