Descemet membrane endothelial keratoplasty for corneal decompensation due to iridoschisis

Abstract

PurposeTo 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).ObservationsA 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 importanceDMEK can be performed safely and successfully after staged cataract surgery with superficial iridectomy in eyes with endothelial decompensation caused by iridoschisis.

Inferior bullous keratopathy caused by iris fibers, resolved with diode laser 532

“…Since iridoschisis occurs more frequently between the fifth and seventh decade of life, and patients of this age group require cataract surgery more often, it is a possibility that in these patients, iridoschisis is exacerbated and causes postoperative complications such as bullous keratopathy. 3,[7][8][9] Loewenstein et al have proposed that iridoschisis could be the result of a trauma, which alters the fibers and could lead to the division of the anterior and posterior stroma of the iris. 3 In the differential diagnosis of this patient, we discarded two other main abnormalities of the iris stroma, the iridocorneal endothelial syndrome, and the Axenfeld-Rieger syndrome.…”

“…These delicate fibers of the iris can make contact with the corneal endothelium, causing endothelial dysfunction with subsequent decompensation and formation of a bullous keratopathy in which a penetrating or endothelial corneal transplant could be required. [1][2][3][4][5][6][7] Here, we present the case of a patient with inferior bullous keratopathy caused by iris strands that resolved with laser diode 532 and Nd-YAG laser shots.…”

Iridoschisis—A Systematic Review

“…Corneal changes are uncommon and, if present, the degenerated corneal endothelial cells are mostly localized above the area of iridoschisis [ 20 , 21 , 22 , 23 , 24 , 25 ]. Visual deterioration is usually caused by glaucoma, cataract or corneal decompensation secondary to iridocorneal touch [ 26 ].…”

“…To the best of our knowledge, there are only a few published cases of localized bullous keratopathy secondary to iridoschisis. Free floating of iris fibers was shown to result in iridocorneal touch and subsequent local endothelial decompensation [ 20 , 22 , 23 , 24 , 25 ]. Total endothelial decompensation has been reported as well [ 21 ].…”

“…We found two published reports documenting the use of endothelial keratoplasty in the treatment of corneal decompensation in patients with iridoschisis [ 23 , 25 ]. Minezaki et al reported on a patient with bullous keratopathy secondary to iridoschisis treated by non-Descemet’s stripping automated endothelial keratoplasty (nDSAEK).…”