Progression of Essential Iris Atrophy Studied With Confocal Microscopy and Ultrasound Biomicroscopy: A 5-Year Case Report

Pezzi, Paola Pivetti; Marenco, Marco; Cosimi, Pamela; Mannino, Giuseppe; Iannetti, Ludovico

doi:10.1097/ico.0b013e3181822579

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…Moreover, the higher the pre-existing iris damage score, the higher the incidence of graft failure. Although the association between iris damage and ECD is a novel result, some clinical entities with iris pigment atrophy, such as iridocorneal endothelial syndrome, have progressive endothelial cell loss 33 34 . The presence of pre- and intraoperative iris damage can cause prolonged postoperative intraocular inflammation, due to the breakdown of the blood-aqueous barrier, which may lead to endothelial cell loss, because previous studies have implied a correlation between ocular inflammation and endothelial cell loss 35 .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with graft survival and endothelial cell density after Descemet’s stripping automated endothelial keratoplasty

Ishii

Yamaguchi

Yazu

et al. 2016

Sci Rep

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Postoperative endothelial cell loss leads to graft failure after corneal transplantation, and is one of the important issues for long-term prognosis. The objective of this study was to identify clinical factors affecting graft survival and postoperative endothelial cell density (ECD) after Descemet’s stripping automated endothelial keratoplasty (DSAEK). A total of 198 consecutive Japanese patients (225 eyes) who underwent DSAEK were analysed using Cox proportional hazard regression and multiple linear regression models. The candidate factors included recipient age; gender; diagnosis; pre-existing iris damage state, scored based on its severity; the number of previous intraocular surgeries; graft ECD; graft diameter; simultaneous cataract surgery; surgeons experience; intraoperative iris damage; postoperative rebubbling; and graft rejection. Eyes with higher pre-existing iris damage score and more number of previous intraocular surgery had a significantly higher risk of graft failure (HR = 8.53; P < 0.0001, and HR = 2.66; P = 0.026, respectively). Higher pre-existing iris damage score, lower graft ECD, and smaller graft diameter were identified as significant predisposing factors for lower postoperative ECD. The results show that iris damage status before DSAEK may be clinically useful in predicting the postoperative course. Avoiding intraoperative iris damage, especially in eyes with low ECD can change the prognosis of future DSAEK.

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Section: Discussionmentioning

confidence: 99%

Factors associated with graft survival and endothelial cell density after Descemet’s stripping automated endothelial keratoplasty

Ishii

Yamaguchi

Yazu

et al. 2016

Sci Rep

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“…Different “epithelial-like” presentations of endothelial cells have been described at IVCM: one type of abnormal endothelium with quite regular size and shape, a second cell type more irregular in size and shape, similar to the epithelial wing cells on IVCM, and a third, highly irregular cell pattern resembling a surface corneal epithelium. It has been hypothesized that these different observations may be related to the stage of the disease [ 21 , 39 , 40 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

Diagnosis and Management of Iridocorneal Endothelial Syndrome

Sacchetti

Mantelli

Marenco³

et al. 2015

BioMed Research International

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The iridocorneal endothelial (ICE) syndrome is a rare ocular disorder that includes a group of conditions characterized by structural and proliferative abnormalities of the corneal endothelium, the anterior chamber angle, and the iris. Common clinical features include corneal edema, secondary glaucoma, iris atrophy, and pupillary anomalies, ranging from distortion to polycoria. The main subtypes of this syndrome are the progressive iris atrophy, the Cogan-Reese syndrome, and the Chandler syndrome. ICE syndrome is usually diagnosed in women in the adult age. Clinical history and complete eye examination including tonometry and gonioscopy are necessary to reach a diagnosis. Imaging techniques, such as in vivo confocal microscopy and ultrasound biomicroscopy, are used to confirm the diagnosis by revealing the presence of “ICE-cells” on the corneal endothelium and the structural changes of the anterior chamber angle. An early diagnosis is helpful to better manage the most challenging complications such as secondary glaucoma and corneal edema. Treatment of ICE-related glaucoma often requires glaucoma filtering surgery with antifibrotic agents and the use of glaucoma drainage implants should be considered early in the management of these patients. Visual impairment and pain associated with corneal edema can be successfully managed with endothelial keratoplasty.

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“…Hyphaema does not occur. Progression of the disease can be monitored using confocal microscopy [3], and ultrasound biomicroscopy [4].…”

Section: Introductionmentioning

confidence: 99%

The frequency of secondary glaucoma in patients with iridocorneal endothelial syndrome in correlation to the presence of uveal ectropion

et al. 2017

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Introduction/Objective Iridocorneal endothelial (ICE) syndrome incudes 3 clinical forms: progressive iris atrophy, Chandler's syndrome, and Cogan-Reese syndrome. It is characterized by various degrees of iris atrophy, corneal endothelial changes, uveal ectropion, corectopia, peripheral anterior synechiae (PAS) and secondary glaucoma. The aim of the study was to illustrate forms of ICE syndrome, determine frequency of secondary glaucoma with emphasis on cases with uveal ectropion, analyze response to medicament treatment and the need for surgical treatment in intraocular pressure (IOP) control. Methods Patients underwent slit lamp examination, applanation tonometry, gonioscopy, ophthalmoscopy, Humphrey visual field testing and Heidelberg retina tomography. Patients were divided into two groups: group I, without uveal ectropion (22 patients) and group II, with uveal ectropion (14 patients). Results A total of 36 patients were examined in a 10-year period. The average age was 38 years, male to female ratio 1:2. Secondary glaucoma was confirmed in 26 (72.2%) patients, out of which 12 (54.5%) in group I and 14 (100%) in group II. PAS were more frequent in group II. In group I, mean initial IOP was 37 mmHg, and after medicament treatment 26 mmHg. Secondary glaucoma was controlled in 50% and remaining 50% underwent surgical treatment. In group II, mean initial IOP was 49 mmHg, and after medicament treatment 32 mmHg. All 14 patients (100%) underwent surgical treatment in order to achieve IOP control. Conclusion ICE syndrome is a rare, progressive disease, with high incidence of secondary glaucoma, which is more frequent in cases with uveal ectropion. In these cases, medicament treatment is not effective and trabeculectomy with antimetabolite application is necessary.

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Progression of Essential Iris Atrophy Studied With Confocal Microscopy and Ultrasound Biomicroscopy: A 5-Year Case Report

Abstract: UBM and confocal microscopy permit observation of any corneal and iridocorneal angle changes and evaluation of essential iris atrophy progression.

Cited by 6 publications

References 8 publications

Factors associated with graft survival and endothelial cell density after Descemet’s stripping automated endothelial keratoplasty

Factors associated with graft survival and endothelial cell density after Descemet’s stripping automated endothelial keratoplasty

Diagnosis and Management of Iridocorneal Endothelial Syndrome

The frequency of secondary glaucoma in patients with iridocorneal endothelial syndrome in correlation to the presence of uveal ectropion

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