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Lombardo M, Meliante LA, Di Marco E, Ricci F, Nucci C, Cesareo M. The natural course of an iridoschisis: A case report. Eur J Ophthalmol 2024; 34:NP24-NP27. [PMID: 39056137 DOI: 10.1177/11206721241266001] [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] [Indexed: 07/28/2024]
Abstract
BACKGROUND Iridoschisis is a rare ophthalmological disorder that presents with the separation of the anterior fibers of the iris from the posterior ones at the level of the stromal layer. Fibers resulting from the disintegration of the anterior iris layers can be encountered in the anterior chamber of the affected eyes. This condition mostly affects females and has been associated with both open-angle and angle-closure glaucoma. The pathogenesis has not been clarified yet, and the treatment is still a matter of discussion. OBJECTIVE We want to contribute to the understanding of the pathogenesis and natural course of the disease as well as to document with multimodal imaging a new case of this very rare disease. CASE REPORT We present a case of a 71-year-old woman affected by iridoschisis in both eyes followed by 3 consecutive visits every 4 months. We performed an extensive ophthalmologic examination, including gonioscopy, endothelial cell microscopy, and optical coherence tomography of the anterior segment. CONCLUSION In our report, we documented a possible natural course of iridoschisis, characterized by an acute worsening followed by a phase of stability, and formulated some hypotheses on the pathogenesis of this rare disease.
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Affiliation(s)
- Marco Lombardo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Laura Antonia Meliante
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ernesto Di Marco
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ricci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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Ben Aoun S, Hachicha I, Bouraoui R, Matri KE, Limaiem R, Matri LE. Atypical presentation of bilateral iridoschisis with abnormal visibility of iris vessels: Role of anterior segment optical coherence tomography. Eur J Ophthalmol 2024; 34:NP38-NP42. [PMID: 37801513 DOI: 10.1177/11206721231206792] [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] [Indexed: 10/08/2023]
Abstract
PURPOSE To describe clinical and anterior segment optical coherence tomography (AS-OCT) findings in a patient with bilateral iridoschisis and unilateral angle closure glaucoma (ACG) associated with abnormal visibility of iris vessels. CASE PRESENTATION A 67-year-old male patient with a history of red and painful left eye (LE) one year earlier, presented to our ophthalmology department for a routine examination.Ophthalmic examination of the right eye revealed narrow anterior chamber with sectorial iris atrophy associated to abnormal visibility of an iris vessel. Intraocular pressure (IOP) was 12 mmHg with normal optic disc appearance. LE anterior chamber was narrow with diffuse iris atrophy and abnormal vessels visibility. IOP was 28 mmHg with an important optic disc excavation. On gonioscopy, angle was narrow without neovessels nor synechiae. AS-OCT of both eyes revealed shallow angles, iris splitting with material release in the anterior chamber, while pigmented epithelium was preservedAnti-glaucoma eye drops were prescribed and peripheral laser iridotomy was performed in both eyes with decreased IOP at 14 mmHg in the LE. CONCLUSION Iridoschisis is a rare ocular condition characterized by a separation between the anterior and posterior layers of iris stroma with several clinical presentations, and may be associated with abnormal visibility of iris vessels in some cases. The diagnosis of iridoschisis may be challenging and AS-OCT can be a very useful tool to confirm the diagnosis in atypical presentations and to detect associated angle closure.
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Affiliation(s)
- Safa Ben Aoun
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
| | - Ines Hachicha
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
| | - Rim Bouraoui
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunisia
| | - Khaled El Matri
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunisia
| | - Rim Limaiem
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunisia
| | - Leila El Matri
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunisia
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Niu TT, Xin WJ. A case of iridoschisis with partial lens dislocation in both eyes. BMC Ophthalmol 2024; 24:66. [PMID: 38355462 PMCID: PMC10865630 DOI: 10.1186/s12886-024-03330-y] [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: 10/20/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Iridoschisis is a rare condition that primarily affects individuals aged 60-70 years. The predominant characteristics of iridoschisis involve the tissue splitting and separation of the iris stromal layers, often resulting in two distinct layers and the presence of floating fibers in the anterior chamber. This article reports the case of a 48-year-old male with iridoschisis with partial lens dislocation in both eyes. CASE PRESENTATION Trauma is the leading factor in the development of iridoschisis. However, there is no documented case of ocular trauma in the patient's medical history. Visible white atrophic fibers were observed bilaterally in the anterior iris stroma of both eyes of the individual, accompanied by a small quantity of iris tissue within the anterior chamber. In this instance, the magnitude of the iridoschisis corresponded with the degree of lens dislocation. We were apprised that the patient had regularly used a cervical massager for a prolonged period of time, positioning it upon the ocular region. Frequent stimulation of both eyes with excessive force resulted in the development of iridoschisis and the partial dislocation of the lens.During the initial surgical procedure, phacoemulsification (Phaco) was carried out on the left eye without the placement of an intraocular lens (IOL). Following a two-month interval, we proceeded with the IOL suspension. Subsequently, the right eye underwent Phaco, accompanied by the implantation of an IOL. After closely monitoring the patient's progress for two months, it was evident that their vision had significantly improved, substantiating the success of the surgical interventions. CONCLUSIONS This finding posits that the recurrent friction applied to both eyes may induce iridoschisis and various ocular complications. In the event of ocular intricacies manifesting, expeditious medical intervention becomes imperative.
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Affiliation(s)
- Tong-Tong Niu
- Department of Ophthalmology, Xinjiang 474 Hospital, Urumchi, 830000, China
| | - Wen-Jian Xin
- Department of Ophthalmology, Xinjiang 474 Hospital, Urumchi, 830000, China.
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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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5
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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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Abdellaoui T, Malek Y, Akioud W, Belfaiza S, Elasri F, Reda K, Oubaaz A. Unilateral iridoschisis. J Fr Ophtalmol 2020; 43:1103-1104. [PMID: 32921523 DOI: 10.1016/j.jfo.2020.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- T Abdellaoui
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco.
| | - Y Malek
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco
| | - W Akioud
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco
| | - S Belfaiza
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco
| | - F Elasri
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco
| | - K Reda
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco
| | - A Oubaaz
- Department of ophthalmology, Military teaching hospital Med-V, Rabat, Morocco
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Pieklarz B, Grochowski ET, Dmuchowska DA, Saeed E, Sidorczuk P, Mariak Z. Iris-Claw Lens Implantation in a Patient with Iridoschisis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925234. [PMID: 32857754 PMCID: PMC7483544 DOI: 10.12659/ajcr.925234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iridoschisis is a rare condition defined as a separation of anterior iris stroma from the posterior stroma and muscle layers. The etiopathogenesis of iridoschisis is not fully understood. We report the case of uveitis-glaucoma-hyphema (UGH) syndrome related to the iris-claw lens implantation in a patient with iridoschisis, and propose an alternative approach to aphakia correction. CASE REPORT A 47-year-old male was referred to our department with bilateral iridoschisis, associated lens subluxation, mature cataract, and secondary glaucoma. The patient underwent bilateral surgery, with entirely different anterior segment results depending on the method of artificial lens implantation. To the best of our knowledge, iris-claw implantation in iridoschisis and the potential association of iridoschisis with increased risk of UGH syndrome, have not been reported previously. CONCLUSIONS Due to the possibly increased risk of UGH syndrome in patients with iridoschisis, one may consider treating aphakia by implantation of scleral fixated lenses, rather than iris-claw lenses.
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Affiliation(s)
- Barbara Pieklarz
- Department of Ophthalmology, University Teaching Hospital of Białystok, Białystok, Poland
| | - Emil T Grochowski
- Department of Ophthalmology, University Teaching Hospital of Białystok, Białystok, Poland
| | - Diana A Dmuchowska
- Department of Ophthalmology, University Teaching Hospital of Białystok, Białystok, Poland
| | - Emil Saeed
- Department of Ophthalmology, University Teaching Hospital of Białystok, Białystok, Poland
| | - Patryk Sidorczuk
- Department of Ophthalmology, University Teaching Hospital of Białystok, Białystok, Poland
| | - Zofia Mariak
- Department of Ophthalmology, University Teaching Hospital of Białystok, Białystok, Poland
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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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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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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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12
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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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13
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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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Abstract
PURPOSE OF REVIEW Presence of a small pupil is still considered a major challenge for cataract surgeons. Appropriate mydriasis and maintaining it is of paramount importance to prevent potential serious complications. Recently, more interventions and instruments are available for the cataract surgeons to deal with these challenging cases. The intention of this review is to discuss the preoperative and intraoperative considerations and techniques for cataract surgery in small pupil and related conditions and to discuss new developments in management of small pupil in femtosecond laser-assisted cataract surgery. RECENT FINDINGS There are new techniques and pharmaceuticals available to cataract surgeons in the setting of small pupil. Intracameral ketorolac may soon be available to maintain mydriasis and to control pain and inflammation. Malyugin ring has been added to pupil expansion rings and has already been used for small pupil in different settings. In femtosecond laser-assisted cataract surgery, presence of a small pupil can now be managed by applying intracameral mydriatics and intraocular devices successfully. SUMMARY Accurate preoperative examinations adjunct with intraoperative use of appropriate pharmacologic and mechanical devices can yield favorable outcomes in cataract surgery with a small pupil.
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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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Minezaki T, Hattori T, Nakagawa H, Kumakura S, Goto H. Non-Descemet's stripping automated endothelial keratoplasty for bullous keratopathy secondary to iridoschisis. Clin Ophthalmol 2013; 7:1353-5. [PMID: 23861578 PMCID: PMC3704543 DOI: 10.2147/opth.s43180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Teruumi Minezaki
- Department of Ophthalmology, Tokyo Medical University, Shinjukuku, Tokyo, Japan
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Khan AO, Aldahmesh MA, Mohamed JY, Alkuraya FS. Congenital glaucoma with acquired peripheral circumferential iris degeneration. J AAPOS 2013; 17:105-7. [PMID: 23363883 DOI: 10.1016/j.jaapos.2012.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/25/2012] [Accepted: 09/29/2012] [Indexed: 11/30/2022]
Abstract
Iris anomalies associated with congenital or early-childhood glaucoma include stable primary developmental abnormalities such as those associated with the Axenfeld-Rieger spectrum and aniridia. Secondary generalized iris atrophy from uncontrolled intraocular pressure is another potential iris finding in pediatric glaucoma. We document an unusual pattern of acquired peripheral circumferential iris degeneration in 2 unrelated children with otherwise-controlled congenital glaucoma. Genetic testing revealed a common homozygous CYP1B1 mutation in one (p.Gly61Glu) and a novel heterozygous FOXC1 deletion in the other (p.Tyr81_Pro95del).
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Affiliation(s)
- Arif O Khan
- Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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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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