Refractory glaucoma secondary to iridocorneal syndrome treated with drainage implant

Abstract

Purpose The iridocorneal endothelial (ICE) syndrome is a rare proliferative corneal endotheliopathy of unknown etiology. Common manifestations include corneal edema,iris stromal abnormalities, peripheral anterior synechiae and glaucoma, which does not usually respond to medical treatment. We want to know what is the most successful surgical practice for the control of intraocular presure (IOP) in these patients. Methods We presents a case of man of 27 years with ocular hypertension in the right eye (RE) difficult to control for 6 months. AV 8/10 in his RE. Iris atrophy with corectopia, uveal ectropion and peripheral anterior synechiae were observed in RE. Abnormalities of angle and endothelial disruption without corneal edema led to a diagnosis of ICE syndrome. We performed an Ahmed valve implant in that eye. Two months after surgery the IOP remains controlled with topical beta‐blocker. Results The ICE syndrome is usually unilateral disorder that can develop glaucoma resistant to medical treatment. There is a lack of consensus on the surgical technique of choice. It is described a higher survival rate of valve implants on trabeculectomy at 3 and 5 years as well as higher rates of failure than other glaucoma, due to endothelialization of the fistula. The use of Mitomycin would be indicated in these cases. Conclusion When is not possible to perform a classical filtering surgery due to angle morphological characteristics, the placement of a valve implant should be considered.