Title : An audit of rubeosis iridis management: Identifying key areas for clinical improvement and guideline standardization
Abstract:
Background: Rubeosis iridis, characterized by neovascularization of the iris and anterior chamber angle, presents significant clinical risks including neovascular glaucoma, vision loss, and ocular discomfort. Timely diagnosis and intervention are critical components of effective patient management and visual prognosis. Despite established treatment recommendations, adherence and implementation remain variable, highlighting the need for standardized and evidence-based clinical guidelines.
Methods: A retrospective audit was conducted on patients diagnosed with rubeosis iridis presenting to Manchester Royal Eye Hospital between June 2024 and July 2025. Data from 56 eligible patients were analyzed from electronic medical records. Compliance with existing clinical guidelines was classified as "fully compliant," "partially compliant," or "not compliant." The key audited outcomes included timely administration of pan-retinal photocoagulation (PRP), appropriate medical therapies, intravitreal anti-VEGF (Avastin) injections, and referrals to glaucoma specialists.
Results: Significant deviations from clinical guidelines were identified. Among patients with normal intraocular pressure (IOP, n=23), 57% did not receive PRP within the recommended two-week period, and 48% experienced delays exceeding the recommended four-week follow-up with medical retina specialists. In patients with moderate IOP elevation (24-35 mmHg, n=16), atropine was omitted in 88% of cases, and Pred Forte was omitted in 75%. Avastin injections were delayed beyond the recommended 24 hours in 63% of cases, with an average delay of 3.6 days. Additionally, glaucoma specialist reviews were delayed on average by seven weeks rather than the advised 2-4 weeks. In patients with elevated IOP (>35 mmHg, n=17), critical medications such as apraclonidine and Diamox were missed in 29% and 18%, respectively. Documentation of urgent IOP rechecks and liaison with glaucoma services frequently fell short of optimal standards.
Conclusions: The findings of this audit underscore critical gaps in adherence to established guidelines for managing rubeosis iridis in the UK. These results have broader relevance, highlighting common areas in clinical practice where improvements can significantly impact patient outcomes. They emphasize the necessity for universally applicable, standardized guidelines informed by evidence-based medicine. Implementation of standardized clinical proformas, validated guideline clarification, and improved interdisciplinary communication are recommended steps towards achieving consistent, high-quality care for patients with rubeosis iridis.
