Iridoschisis

Iridoschisis: Spectrum of Presentation

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.

Iridoschisis-A Systematic Review

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.

Iridoschisis: a case report and literature review

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.

[Isolated bilateral Iridoschisis]

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.

Non-Descemet's stripping automated endothelial keratoplasty for bullous keratopathy secondary to iridoschisis

Purpose

To report a case of bullous keratopathy secondary to iridoschisis treated by non-Descemet’s stripping automated endothelial keratoplasty (nDSAEK).

Case report

A 79-year-old woman was referred to our hospital with loss of vision in the left eye. Slit lamp examination of her left eye showed a shallow anterior chamber with cataract and schisis in the inferior quadrant of iris stroma. Bullous keratopathy secondary to iridoschisis was diagnosed. Cataract surgery with iridectomy succeeded to deepen the anterior chamber and remove the floating iris leaf, although corneal edema remained. Four days later, nDSAEK was performed, which resolved corneal edema and restored visual acuity.

Conclusion

The two-step surgery of cataract surgery plus iridectomy followed by nDSAEK may be an effective strategy for treating bullous keratopathy secondary to iridoschisis.

Iridoschisis: case report and review of the literature

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.

[Iridoschisis and angle-closure glaucoma: a case report]

INTRODUCTION

Iridoschisis is a rare condition where a localized area of iris stroma is cleaved in two, with the anterior atrophic portion disintegrating into fibrils. It is frequently associated with angle closure glaucoma and with cataract.

CASE REPORT

A 70-year-old male presented with reduction of visual acuity in the left eye. Visual acuity was 20/25 OD and 20/70 OS. He had suffered acute angle-closure glaucoma in the right eye 10 years before, treated with laser iridotomy and topical antiglaucomatous therapy. Intraocular pressure was 12 mmHg OD and 46 mmHg OS. Slit lamp biomicroscopic examination revealed bilateral shallow anterior chamber, iris atrophy, and leaf degeneration of the iris stroma. A-scan and B-scan standardized echography in both eyes showed shortening of the anterior chamber, a thickened and more anteriorly located lens, the presence of a few hyperechogeneous flocculated masses floating in the vitreous, and optic disc excavation.

CONCLUSION

The mechanism by which iridoschisis causes angle closure is unclear. A pupillary block could be favored by the thickening and anteriorization of the lens and the ciliary processes. Both the presence of strings of iris stroma occluding the trabecula and pupillary block could cause an elevation in intraocular pressure.