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Katipoğlu Z, Turan M. A case report of iridoschisis and cataract: a challenging diagnosis. Int Ophthalmol 2024; 44:26. [PMID: 38326697 DOI: 10.1007/s10792-024-03001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE To report the cataract surgery of a 79-year-old female patient with iridoschisis and senile nuclear cataracts. OBSERVATIONS Ophthalmologic examination of the 79-year-old female patient who came to our clinic with complaints of decreased vision in the right eye was observed to have a grade-3 senile nuclear cataract and iridoschisis in quadrants 2-3, 4-7, and 10-11 of the iris in the right eye and a grade-2 senile nuclear cataract and iridoschisis in quadrants 5-7 in the left eye to a lesser extent compared to the right eye. The iris fibrils were not connected to the corneal endothelium. A safe surgical area was created by administering the viscoelastic material several times during cataract surgery. CONCLUSIONS AND IMPORTANCE Although iridoschisis has a low incidence rate, it is important to also consider comorbid ocular pathologies when treating iridoschisis patients. Since cataract surgery for these patients is more specialized than for uncomplicated cases, the necessary surgical planning must be paid due diligence.
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Affiliation(s)
- Zeynep Katipoğlu
- Department of Ophthalmology, Balıkesir Atatürk City Hospital, Balıkesir, Turkey.
| | - Meydan Turan
- University of Health Sciences University Balıkesir Atatürk City Hospital, Balıkesir, Turkey
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2
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Pegu J, Jain K, Dubey S. Iridoschisis: Spectrum of Presentation. Middle East Afr J Ophthalmol 2021; 27:224-227. [PMID: 33814819 PMCID: PMC7993048 DOI: 10.4103/meajo.meajo_120_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 09/19/2020] [Accepted: 12/29/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE: The purpose of the study was to report a small case series of patients with iridoschisis seen at our hospital over a period of 5 years. METHODS: Retrospective review of all those files over the past 5 years whereby the diagnosis of iridoschisis/iris atrophy/iris fibrils in anterior chamber (AC) was made. RESULTS: In our case series, the average age at presentation was 49 years (range: 23–85 years). The pathology was bilateral in 57% of patients in our series. Our most common presentations were angle closure glaucoma and cataract. Younger individuals can also manifest iridoschisis. CONCLUSION: The iridoschisis can be an incidental finding, and gonioscopy should be performed in all the cases, as occludable or synechiael angle closure may be present in these cases.
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Affiliation(s)
- Julie Pegu
- Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Kanika Jain
- Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Suneeta Dubey
- Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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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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Greenwald MF, Niles PI, Johnson AT, Vislisel JM, Greiner MA. Descemet membrane endothelial keratoplasty for corneal decompensation due to iridoschisis. Am J Ophthalmol Case Rep 2018; 9:34-37. [PMID: 29468215 PMCID: PMC5786877 DOI: 10.1016/j.ajoc.2018.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 10/03/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose To report a case of bilateral iridoschisis with cataracts and corneal decompensation in a patient who underwent cataract extraction and superficial iridectomy followed by Descemet membrane endothelial keratoplasty (DMEK). Observations A 58-year-old man with previously diagnosed iridoschisis, cataracts, and diabetes mellitus experienced progressive vision loss bilaterally due to corneal decompensation. Slit lamp examination revealed iridoschisis with iris fibrils contacting the corneal endothelium, stromal edema, and mild guttate changes bilaterally. Corneal findings were more severe in the right eye, including the presence of bullous keratopathy at the time of presentation. Cataract extraction with intraocular lens implantation and superficial iridectomy were performed in the right eye, followed by DMEK. These same procedures were performed subsequently in the left eye. Postoperatively, the patient had significant improvement in visual acuity and corneal edema. Conclusions and importance DMEK can be performed safely and successfully after staged cataract surgery with superficial iridectomy in eyes with endothelial decompensation caused by iridoschisis.
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Affiliation(s)
- Miles F Greenwald
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
| | - Philip I Niles
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
| | - A Tim Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
| | - Jesse M Vislisel
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States.,Cornea Research Center, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
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Laaribi N, Ajhoun Y, Ouattassi NE, Chammout FZ, Hanafi Y, Asri FE, Reda K, Oubaaz A. [Iridoschisis: A glaucoma to screen for and an unusual phacoemulsification]. J Fr Ophtalmol 2017; 40:e299-e301. [PMID: 28889906 DOI: 10.1016/j.jfo.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- N Laaribi
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc.
| | - Y Ajhoun
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - N El Ouattassi
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - F Z Chammout
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - Y Hanafi
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - F El Asri
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - K Reda
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
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Chen Y, Qian Y, Lu P. Iridoschisis: a case report and literature review. BMC Ophthalmol 2017; 17:24. [PMID: 28288590 PMCID: PMC5348740 DOI: 10.1186/s12886-017-0418-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Iridoschisis is a rare condition that is characterized by the separation of the iris stroma into layers, with portions of the anterior layer floating freely in the aqueous humour. Here, we report three cases of iridoschisis that were complicated by either a cataract or glaucoma. Based on these cases, we speculate that the scope of iridoschisis has a rare association with intraocular pressure and the loss of corneal endothelial cells after surgery, which is mainly due to the surgery and not iridocorneal mechanical contact. Case presentation We report three cases of iridoschisis, two of which were complicated by cataracts and the third by glaucoma. Patient 1 was a 69-year-old man with bilateral iridoschisis complicated by a cataract but not glaucoma, even though the entire anterior layer of the iris stroma in the right eye presented as white atrophic strands. To prevent the detached iris fibrils from invading the phacoemulsification tip and the irrigation/aspiration hand piece port, the separated iris stroma that was floating freely in the aqueous humour was cut with scissors immediately before the cataract extraction. Patient 2 was an 87-year-old woman with iridoschisis complicated by a cataract in the right eye. We successfully performed cataract surgery on the right eye without a pupillary device. Patient 3 was a 66-year-old man who presented with increased intraocular pressure with bilateral iridoschisis. He was discharged and prescribed with a combination of four glaucoma drugs. Conclusions Patients with iridoschisis should have continuous follow-up because complications may occur, and extra care from ophthalmologists is required.
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Affiliation(s)
- Yiyi Chen
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Yiyong Qian
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Peirong Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China.
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Lee EJ, Lee JH, Hyon JY, Kim MK, Wee WR. A case of cataract surgery without pupillary device in the eye with iridoschisis. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 22:58-62. [PMID: 18323708 PMCID: PMC2644092 DOI: 10.3341/kjo.2008.22.1.58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To introduce a case of iridoschisis patient who underwent cataract surgery successfully without pupil device. Methods A 64-year-old female who showed iridoschisis of her both eyes underwent cataract operation at her right eye without a pupillary device. The preoperative and postoperative ophthalmologic examinations including visual acuity, intraocular pressure, reaction of anterior chamber, and degree of damage on iris was evaluated respectively. Results Cataract surgery was performed under topical anesthesia through a clear corneal incision. Iris fibrils were held in place by ophthalmic viscosurgical device (OVD, sodium hyaluronate 3%-sodium chondroitin sulfate 4%, Viscoat®) that was injected into the anterior chamber. A small capsulorrhexis was made and the nucleus was delivered with low-power phacoemulsification, most of which was performed under the anterior capsule. The iris came into contact with the OVDs only and received no mechanical trauma. There were no intraoperative complications such as tear of the iris, hyphema, loss of mydriasis, or rupture of the posterior lens capsule. The edema of corneal stroma and inflammation of anterior chamber was shown at immediate-postoperative period, but completely subsided 2 weeks later. The visual acuity showed improvement from 20/400 to 20/30. Conclusions In iridoschisis patients, there is a risk of aspiration of iris fibers during cataract surgery. With adequate use of OVD and careful modulation of surgical devices, cataract surgery was successfully performed without using extra pupil-supporting device.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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