Iris retraction syndrome associated with nonrhegmatogenous retinal detachment

Abstract

ABSTRACT.Purpose: To present the first documentation of iris retraction syndrome in eyes with nonrhegmatogenous retinal detachment. Patients and Methods: One patient with age-related macular degeneration and another with panuveitis developed exudative retinal detachment with iris retraction configuration. Ultrasound biomicroscopy was performed to investigate the anatomic relationship of structures in the anterior segment of the eye. Results: Ultrasound biomicroscopy demonstrated a severe backward bowing of the peripheral iris with irido-ciliary body and irido-zonular contact as well as broad iris lens touch. The iris retraction syndrome resolved after pupil dilation and disruption of the pupillary adhesions in both cases. The retinal detachment resolved several months later, without surgery. Conclusion:Iris retraction syndrome appears not to be exclusive to rhegmatogenous retinal detachment but can present in eyes with exudative -nonrhegmatogenous retinal detachment. Thus, when the configuration of the iris shows bowing in patients with retinal detachment, iris retraction syndrome should be considered and prompt pupil dilation should be carried out.Key words: iris retraction syndrome (IRS) -retinal detachment -ultrasound biomicroscopy (UBM), anterior-eye-segment-ultrasonography. Acta Ophthalmol. Scand. 1998: 76: 617-619 Copyright C Acta Ophthalmol Scand 1998. ISSN 1395-3907 I ris retraction syndrome (IRS) was originally described in the European literature over 40 years ago (Graham 1958) with only 3 reports of this condition appearing in American publications to date. IRS is defined by the triad of symptoms including backward bowing of the peripheral iris and rhegmatogenous retinal detachment (Hirschberg 1929;Graham 1958;Lindner 1936;Campbell 1984;Morinelli et al. 1996). We present two cases in which the configuration of the iris retraction appeared together with an exudative nonrhegmatogeous retinal detachment. We suspect that IRS is more common than believed and that more such cases may be detected as a result of greater awareness on the part of the physician who can then implement prompt and appropriate treatment to resolve the IRS. Case 1A 78-year-old man with a history of agerelated macular degeneration (AMD) was examined because of decreased vision in his right eye. The medical history and results of physical examination were noncontributory. Corrected vision was limited to counting fingers in the right eye and 1.0 (20/20) in the left eye. The intraocular pressure was 18 mmHg and the anterior segments were essentially normal in both eyes. Ophthalmoscopy revealed a subretinal haemorrhage in the posterior pole of the right eye. Fundus examination of the left eye showed macular drusen. Observation without treatment was recommended. Three months later, the condition of the left eye was unchanged; the visual acuity in the right eye had deteriorated to hand movements and the intraocular pressure dropped to 10 mmHg. Examination of the anterior segment of the right eye showed a clear cornea, an extremely deep ...

Iris Retraction Without Hypotony

“…Geyer is the only other author to report IRS in patients without RD; however, IRS in his patients resolved with pupillary dilation, while bilateral iris retraction in our patient persisted with dilation, as seen in Fig. 2 [ 17 ].…”

“…Mechanical traction on anterior structures was proposed by Jarret when he noted PVR in eyes with a posteriorly bowing iris following RD [ 26 ]. The term “iris retraction syndrome” was not coined until 1984, and both Cambell’s original explanation and Geyer’s subsequent amendment in 1998 require hypotony as a key physiological step [ 17 , 27 ]. In summary, all documented cases of posterior iris bowing from Schnaubel in 1876 to Geyer in 1998 occur in the setting of hypotony due to either rhegmatogenous RD or ciliary body shutdown.…”

“…“Iris retraction syndrome” (IRS) was initially described by Campbell in 1984 as a phenomenon that may follow rhegmatogenous RD, where reabsorption of fluid though the retinal pigment epithelium (RPE) pump at a rate exceeding production by the ciliary body causes retrograde aqueous flow and posterior iris bowing. This general mechanism was annotated by Geyer, who demonstrated that IRS may occur in the absence of RD when chronic inflammation causes decreased aqueous production and extreme hypotony permits retrograde flow through Schlemm’s canal [ 17 ]. Regardless of the supposed mechanism, in all documented cases of iris retraction, hypotony is considered an essential component.…”

Management of Iris Retraction Syndrome with Heterochromia and Retinal Detachment

“…Our patient's visual acuity remained 20/200, despite successful retinal detachment repair and management of iris retraction. Campbell demonstrated how iris retraction and iris bombé can be associated, by noting the conversion to iris retraction with the administration of aqueous suppressants to his patients with iris bombé and return to iris bombé again when the medication was stopped [ 6 ]. Given this, laser peripheral iridotomy should be considered in patients with IRS to prevent subsequent episodes of angle closure glaucoma, as occurred in our patient.…”

“…In 1984, Campbell [ 5 ] was the first to name the condition IRS and proposed the most commonly accepted mechanism for the condition, in which seclusion of the pupil and egress of subretinal fluid are the drivers of iris retraction. However, debate remains regarding the mechanism of fluid egress that leads to hypotony, as Geyer et al [ 6 ] reported 2 cases of IRS associated with nonrhegmatogenous retinal detachment. In 1996, Morinelli et al [ 7 ] demonstrated with ultrasonography the characteristic anterior chamber appearance of IRS.…”