Case study: Rubeosis iridis in a newborn with diabetic fethopathy

Introduction: The diabetic pregnancy is unique with a diversity of organ systems affected in the fetus. Infants of diabetic mothers present with an increased risk of morbiditiy and mortality related to congenital malformation and/or diabetic fetopathy including macrosomia, hypertrophic cardiomyopathy, respiratory compromise and hypoglycemia. In contrast to adults, ophthalmologic pathologies are not described.

Case study: We here present a macrosomic newborn with diabetic fetopathy with a gestational age of week 37/2. Postnatal adaptation was impaired (APGAR 5/5/7) and nasal CPAP had to be applied due to respiratory distress. Severe hypoglycaemia had to be treated with intravenous glucose. Echocardiography revealed hypertrophic cardiomyopathy with left ventricular outflow tract obstruction needing beta-blocker treatment. Cerebral ultrasound at the first day of life revealed a single sided intraventricular hemorrhage, MRI was performed to exclude any additional intracerebral malformations. In a routine ophthalmologic examination circular rubeosis iridis (neovascularisation of the pupillar margin) was detected. To exclude elevated intraoccular pressure, impression tonometry was performed, revealing normal values during all follow examinations. Opthalmoscopy using a Retcam® was performed for documentation and excluded neovascularisaion of the optic disc or retina.

Conclusion: Rubeosis iridis may be a feature of diabetic fetopathy, opthalmologic examination of infants of diabetic mothers may be indicated.

Diabetes - fetopathy - rubeosis iridis