Iridotrabecular and Iridocorneal Contact Changes after Cataract Surgery and Endothelial Keratoplasty in Bilateral Iridoschisis

Abstract

We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

Iridoschisis misdiagnosed as acute angle-closure glaucoma: a case report and literature review

“…Iridoschisis occurs mostly in patients of 60 to 70 years of age, and its etiology is still unclear. Angle-closure glaucoma is a common problem associated with iridoschisis, whereas corneal endothelial decompensation is relatively rare, as previously reported [3][4][5][6] . Other complications include cataracts, lens dislocation, keratoconus, and syphilitic interstitial keratitis [3][4][5][6] .…”

“…Angle-closure glaucoma is a common problem associated with iridoschisis, whereas corneal endothelial decompensation is relatively rare, as previously reported [3][4][5][6] . Other complications include cataracts, lens dislocation, keratoconus, and syphilitic interstitial keratitis [3][4][5][6] . Generally, iridoschisis without complications does not need treatment.…”

“…In patients undergoing phacoemulsification, corneal endothelial decompensation may occur after surgery, requiring corneal transplantation [13] . Previous studies suggest that bullous keratopathy secondary to iridoschisis can be successfully managed by corneal transplantation, including endothelial keratoplasty, non-Descemet's stripping automated endothelial keratoplasty, or Descemet's membrane endothelial keratoplasty [5,[13][14] . Fortunately, corneal transparency was restored in our patient, and VA improved a week after surgery.…”

“…Patients with iridoschisis and a shallow anterior chamber should be closely followed up for iridotrabecular and iridocorneal contacts. The iridotrabecular contact index or iridocorneal contacts can be assessed by AS-OCT in patients with iridoschisis [5] . To avoid further corneal endothelial injury and secondary glaucoma caused by PAS, cataract surgery should be performed as soon as possible when such contacts are accompanied by reduced endothelial cell density in the cornea.…”

“Capsule drape wrap”—a new technology for iridoschisis management during phacoemulsification

“…The pre-existing iridoschisis can increase the difficulty and risk of cataract surgery because of impaired pupil dilation and the iris fibrils which may interfere with the aspiration by phaco instruments. Therefore, additional post-operative complications may be induced by iridoschisis, for example, the sphincter muscle can be damaged, and the pigmented iris epithelium can be exposed, thereby inducing symptomatic photic phenomena [19][20][21][22] . To protect the iris, several pupil expanding devices are conducive to the surgery, including iris retractors, flexible iris hooks, and pupil expanders [16,[23][24][25][26] .…”