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Iridoschisis-A Systematic Review. J Clin Med 2020; 9:jcm9103324. [PMID: 33081187 PMCID: PMC7602847 DOI: 10.3390/jcm9103324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
Iridoschisis is a rare condition defined as a separation of the anterior iris stroma from the posterior stroma and muscle layers. In this paper, we review current data about the epidemiology, pathophysiology, clinical characteristics and differential diagnoses of this condition and discuss the specificity of surgical treatment of concomitant ocular diseases in iridoschisis patients. Iridoschisis may pose a challenge for both an ophthalmologist in an outpatient setting and an ophthalmic surgeon. Glaucoma, primarily angle-closure glaucoma, is the most often described condition concomitant to iridoschisis. Other ocular abnormalities found relatively often in iridoschisis patients include cataract, lens subluxation and corneal abnormalities. Special attention has been paid to potential complications of cataract surgery and prevention thereof. Beside addressing the practical aspects, we point to discrepancies and suggest topics for further investigation.
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Snyder ME, Malyugin B, Marek SL. Novel approaches to phacoemulsification in iridoschisis. Can J Ophthalmol 2019; 54:e221-e225. [PMID: 31564359 DOI: 10.1016/j.jcjo.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Michael E Snyder
- Cincinnati Eye Institute, Cincinnati, OH; University of Cincinnati, Cincinnati, OH.
| | - Boris Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
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Mohamed K, Lhousseine A, Youssef B, Youssef B. [Isolated bilateral Iridoschisis]. Pan Afr Med J 2016; 24:210. [PMID: 27795805 PMCID: PMC5072853 DOI: 10.11604/pamj.2016.24.210.3628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 05/01/2014] [Indexed: 11/28/2022] Open
Abstract
L’iridoschisis est une pathologie dégénérative rare au cours de laquelle le stroma irien antérieur se clive spontanément du feuillet postérieur. Le feuillet antérieur se dissocie alors en fibrilles flottant dans l’humeur aqueuse. Nous rapportons le cas d’une patiente de 70 ans, consulta pour une baisse d’acuité visuelle progressive et chez qui l’examen biomicroscopique a pu mettre évidence une cataracte sénile évolutive avec un iridoschisis bilatérale isolé. Les causes fréquentes d’atrophie irienne acquises (herpès, dispersion pigmentaire, traumatisme…) sont éliminées. Au cours du suivi, l’atrophie évolue avec multiplication des foyers d’atrophie de deux coté. Le tonus oculaire et le champ visuel restaient normaux. Le diagnostic de cette entité est important puisque son association fréquente au glaucome en impose son dépistage dans le même temps et suivi à long terme.
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Affiliation(s)
- Kriet Mohamed
- Service d'Ophtalmologie, Hôpital Militaire Avicenne, Marrakech, Maroc
| | | | - Bouia Youssef
- Service d'Ophtalmologie, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Bennouk Youssef
- Service d'Ophtalmologie, Hôpital Militaire Avicenne, Marrakech, Maroc
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Yusuf IH, Salmon JF. Iridoschisis and keratoconus in a patient with severe allergic eye disease and compulsive eye rubbing: a case report. J Med Case Rep 2016; 10:134. [PMID: 27225273 PMCID: PMC4880883 DOI: 10.1186/s13256-016-0914-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iridoschisis is a rare disorder characterized by splitting of the anterior and posterior iris stroma, resulting in disintegrated iris fibrils which float freely in the anterior chamber. We report an exceptional case of bilateral iridoschisis occurring in conjunction with keratoconus and severe allergic eye disease. CASE PRESENTATION A 24-year-old white man had had periocular contact dermatitis and allergic eye disease from the age of 3 years. He was allergic to grass, animal hair, and pollen and worked grooming horses. He compulsively rubbed his eyes. There was no history of previous blunt trauma to either eye. There were signs of bilateral iridoschisis and keratoconus with allergic conjunctivitis, all of which were more severe in his right eye. An open drainage angle was identified bilaterally on gonioscopy, excluding primary angle closure. There was no evidence of glaucoma in either eye. CONCLUSIONS There are two previous cases reporting the combination of iridoschisis and keratoconus, but no clear common etiology has been identified. In this case there was no evidence of angle closure but there were signs of allergic conjunctivitis. This amalgamation of signs might be explained on the basis of habitual eye rubbing. Treating the allergic eye disease has attenuated this behavior.
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Affiliation(s)
- Imran H Yusuf
- The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Headley Way, , Headington, Oxford, OX3 9DU, UK
| | - John F Salmon
- The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Headley Way, , Headington, Oxford, OX3 9DU, UK.
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Leffler CT, Schwartz SG, Giliberti FM, Young MT, Bermudez D. What was Glaucoma Called Before the 20th Century? OPHTHALMOLOGY AND EYE DISEASES 2015; 7:21-33. [PMID: 26483611 PMCID: PMC4601337 DOI: 10.4137/oed.s32004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Glaucoma involves a characteristic optic neuropathy, often with elevated intraocular pressure. Before 1850, poor vision with a normal eye appearance, as occurs in primary open-angle glaucoma, was termed amaurosis, gutta serena, or black cataract. Few observers noted palpable hardness of the eye in amaurosis. On the other hand, angle-closure glaucoma can produce a green or gray pupil, and therefore was called, variously, glaucoma (derived from the Greek for glaucous, a nonspecific term connoting blue, green, or light gray) and viriditate oculi. Angle closure, with palpable hardness of the eye, mydriasis, and anterior prominence of the lens, was described in greater detail in the 18th and 19th centuries. The introduction of the ophthalmoscope in 1850 permitted the visualization of the excavated optic neuropathy in eyes with a normal or with a dilated greenish-gray pupil. Physicians developed a better appreciation of the role of intraocular pressure in both conditions, which became subsumed under the rubric “glaucoma”.
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Affiliation(s)
| | - Stephen G Schwartz
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Matthew T Young
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dennis Bermudez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
INTRODUCTION Iridoschisis is a rare condition in which there is localized cleavage of the iris stroma into 2 layers. It can be associated with plateau iris and more often with either angle closure or open-angle glaucoma. It usually presents in later life as a bilateral progressive condition, however, in this article we present a young adult with bilateral iridoschisis and incomplete plateau iris configuration. CASE PRESENTATION We report the case of a 22-year-old male with bilateral sensorineural hearing loss who presented to clinic for general ophthalmology evaluation. He had no prior ocular history. Examination findings revealed bilateral iridoschisis with incomplete plateau iris configuration. His ocular examination was otherwise unremarkable except for bilateral retinal pigment epithelium mottling. His work-up for glaucoma including optic disc evaluation, visual field testing, and imaging was all within normal limits. CONCLUSIONS This case is unusual in its presentation of a young patient with bilateral iridoschisis and incomplete plateau iris configuration. Iridoschisis is more commonly a senile process and the presence of iridoschisis in a young adult prompts a review of congenital causes and associations. Although this patient had no evidence of glaucoma at this time, given the associated risk, it is important that he continue to have regular follow-up at this time.
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Paniagua L, Bande MF, Rodríguez-Ares MT, Piñeiro A. A presentation of iridoschisis with plateau iris: an imaging study. Clin Exp Optom 2015; 98:290-1. [PMID: 25728064 DOI: 10.1111/cxo.12250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Laura Paniagua
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel F Bande
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - María Teresa Rodríguez-Ares
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Piñeiro
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Porteous A, Low S, Younis S, Bloom P. Lens extraction and intraocular lens implant to manage iridoschisis. Clin Exp Ophthalmol 2014; 43:82-3. [PMID: 24827832 DOI: 10.1111/ceo.12361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Alastair Porteous
- Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UK
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Agard E, Malcles A, El Chehab H, Ract-Madoux G, Swalduz B, Aptel F, Denis P, Dot C. [Iridoschisis, a special form of iris atrophy]. J Fr Ophtalmol 2012; 36:368-71. [PMID: 23261208 DOI: 10.1016/j.jfo.2012.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/16/2012] [Accepted: 10/19/2012] [Indexed: 11/25/2022]
Abstract
Iridoschisis is a rare degenerative disease characterized by the separation of the anterior iris stroma from the posterior layer. The anterior layer splits into strands, and the free ends float freely in the anterior chamber. We report the case of a 57-year-old man, in whom we incidentally discovered isolated unilateral iris atrophy. The patient had no history of the common causes of atrophy (herpes, pigment dispersion, ocular trauma, etc.). During follow-up, the atrophy gradually worsened, with an increase in the number and bilaterality of the lesions. Ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) of anterior chamber showed thinning of the anterior iris and cleavage of the iris into two layers, an imaging result which, to our knowledge, has not yet been reported in the literature. Familiarity with iridoschisis is important, due to its frequent association with glaucoma, so that appropriate screening can be carried out at the time of diagnosis and on follow-up.
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Affiliation(s)
- E Agard
- Service d'ophtalmologie, HIA Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
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Wang HB, Hu YX, Feng X. Corneal endothelial decompensation secondary to iridoschisis in degenerative myopic eyes: a case report. Int J Ophthalmol 2012; 5:116-8. [PMID: 22553768 DOI: 10.3980/j.issn.2222-3959.2012.01.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 01/05/2012] [Indexed: 11/02/2022] Open
Affiliation(s)
- Hong-Bin Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Gogaki E, Tsolaki F, Tiganita S, Skatharoudi C, Balatsoukas D. Iridoschisis: case report and review of the literature. Clin Ophthalmol 2011; 5:381-4. [PMID: 21499560 PMCID: PMC3076110 DOI: 10.2147/opth.s17269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Indexed: 11/23/2022] Open
Abstract
Iridoschisis is a rare condition that consists of the separation of the anterior mesodermic layer of the iris. In more than two-thirds of cases it is associated with glaucoma. We report the case of an 80-year-old patient who had bilateral iridoschisis and presented with acute angle-closure glaucoma. The patient was free from a history of ocular trauma or of heritable ocular disease. Chronic open-angle glaucoma, as well as intermittent angle-closure glaucoma, should be excluded in all patients with iridoschisis, and regular follow-up should be established upon diagnosis of the entity.
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Affiliation(s)
- Eleni Gogaki
- Ophthalmology Department, Hippokration General Hospital, Thessaloniki, Greece
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