The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Lindsey R. Baden, M.D., Editor

Neovascular Festoons on the Iris

A B

A
Jagdeep Singh Gandhi, M.B., Ch.B. 74-year-old man with hypertension presented with vision re-
duced to only light perception in his right eye. A relative afferent pupillary
Worcester Royal Hospital
Worcester, United Kingdom defect was observed, and retinal examination showed an occlusion of the
central retinal vein. The abnormal pupillary response was caused by retinal ische-
mia. A hypoperfused retina exudes angiogenic factors such as vascular endothelial
growth factor (VEGF). New vessels formed on the pupil (Panels A and B show low and
high magnification, respectively) and also in the angle, the aqueous drainage sys-
tem that surrounds the iris. Angiogenesis in the angle can occlude the drainage
pathway, causing glaucoma and the complication of a painful, sightless eye. Regres-
sion of iris neovasculature was achieved with the use of intravitreal anti-VEGF
therapy and maintained with the use of scatter laser photocoagulation of the is-
chemic retina. The patient’s vision in the affected eye remained unchanged, and
hypertension was the risk factor associated with this ocular vascular occlusion.
Owing to the severity of disease at baseline, there was no visual improvement.
DOI: 10.1056/NEJMicm1214985
Copyright © 2013 Massachusetts Medical Society.

e24 n engl j med 369;18 nejm.org october 31, 2013

The New England Journal of Medicine

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