A Challenging Approach: Iris Neovascularization and Vitreous Hemorrhage 40 Years after Treatment of Retinal Giant Tear Detachment

Iris neovascularization and vitreous hemorrhages are typical sequels of ischemic retinopathies. Here, we report about a patient who developed marked iris neovascularization without signs of posterior retinal ischemia. A 56-year-old patient developed marked iris neovascularization after surgery for rhegmatogenous retinal detachment due to a giant retinal tear had been performed 40 years earlier. With repeatedly applied intravitreal injections of an anti-VEGF drug being unsuccessful, anterior retinal cryocoagulations with deep indentation by the cryoprobe to somehow touch and coagulate the detached anterior flap of giant tear were carried out. Subsequently, the vitreous hemorrhage cleared without any further intervention, and iris neovascularization subsided. Retinal fluorescein angiogram did not reveal signs of ischemia of the attached central retina. Marked iris neovascularization can disappear after applying peripheral retinal cryocoagulation and laser coagulation. It may lead to the question whether neovascular AMD, potentially associated with macular ischemia, might theoretically be addressable by ablative procedures of the peripheral retina.