Iridoschisis: a case report and literature review

Abstract

Background: Iridoschisis is a rare condition that is characterized by the separation of the iris stroma into layers, with portions of the anterior layer floating freely in the aqueous humour. Here, we report three cases of iridoschisis that were complicated by either a cataract or glaucoma. Based on these cases, we speculate that the scope of iridoschisis has a rare association with intraocular pressure and the loss of corneal endothelial cells after surgery, which is mainly due to the surgery and not iridocorneal mechanical contact. Case presentation: We report three cases of iridoschisis, two of which were complicated by cataracts and the third by glaucoma. Patient 1 was a 69-year-old man with bilateral iridoschisis complicated by a cataract but not glaucoma, even though the entire anterior layer of the iris stroma in the right eye presented as white atrophic strands. To prevent the detached iris fibrils from invading the phacoemulsification tip and the irrigation/aspiration hand piece port, the separated iris stroma that was floating freely in the aqueous humour was cut with scissors immediately before the cataract extraction. Patient 2 was an 87-year-old woman with iridoschisis complicated by a cataract in the right eye. We successfully performed cataract surgery on the right eye without a pupillary device. Patient 3 was a 66-year-old man who presented with increased intraocular pressure with bilateral iridoschisis. He was discharged and prescribed with a combination of four glaucoma drugs. Conclusions: Patients with iridoschisis should have continuous follow-up because complications may occur, and extra care from ophthalmologists is required.

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.…”

Iridoschisis—A Systematic Review

“…However, some researchers suggested that iridoschisis is not inherited but occurs sporadically, secondary to trauma, glaucoma or syphilis [ 2 , 6 , 7 , 8 , 9 ]. Other authors considered iridoschisis age-related atrophy, given that the condition is found predominantly in persons between 60 and 70 years of age [ 10 ]. As reviewed by Mansour, the mean and median ages of 131 patients with iridoschisis were 57 years and 62 years, respectively.…”

“…Anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM) and Scheimpflug imaging are complementary diagnostic options in patients with suspected iridoschisis. ( Figure 3 ) [ 10 , 27 , 28 ]…”

Novel approaches to phacoemulsification in iridoschisis

“…In 2003, Ghanem et al used a vitreous cutter to trim fibres, 31 whereas Chen et al cut the anterior fibres using Vannas scissors. 11 We describe a novel, low-risk, inexpensive microcautery approach to free-fibre management iridoschisis. We also outline principles for minimizing risk during cataract surgery in the setting of iridoschisis.…”

“…Although Chen et al suggest that there is no need for pupil stabilization, 11 these patients have unstable irides by nature because the iris architecture is disrupted. Furthermore, we have noted poorly dilating pupils in patients with iridoschisis.…”