Nineteen blind eyes enucleated for painful angle closure-glaucoma secondary to iris neovascularization (rubeosis iridis) were examined by scanning electron microscopy and correlative light and transmission electron microscopy. Fresh and deparaffinized tissue from patients with diabetes mellitus, central retinal vein occlusion, and retinoblastoma were studied. Scanning electron microscopy revealed extensive peripheral anterior synechia formation and flattening and effacement of the anterior iridic surface by a confluent fibrovascular membrane. New vessels on the anterior iris uniformly were hidden beneath a clinically inapparent, superficial layer of myofibroblasts, ie, fibroblastic cells with smooth muscle differentiation. Myofibroblasts may provide the motive force for synechial closure and ectropion iridis in neovascular glaucoma.
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