Iridoschisis: a case report and literature review

Yiyi Chen,Peirong Lu,Yiyong Qian

doi:10.1186/s12886-017-0418-2

Yiyi Chen, Peirong Lu + Show 1 more

Open Access

https://doi.org/10.1186/s12886-017-0418-2

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Abstract

BackgroundIridoschisis 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 presentationWe 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.ConclusionsPatients with iridoschisis should have continuous follow-up because complications may occur, and extra care from ophthalmologists is required.

Highlights

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
Iridoschisis is a rare condition in which the stroma of the iris is cleaved into two or more layers, and atrophy causes the anterior portion to disintegrate into fibrils with free ends that float in the anterior chamber (AC) [1, 2]
Iridoschisis is an age-related condition that is usually accompanied by cataracts, secondary glaucoma, or corneal endothelial decompensation

Summary

Background

Iridoschisis is a rare condition in which the stroma of the iris is cleaved into two or more layers, and atrophy causes the anterior portion to disintegrate into fibrils with free ends that float in the anterior chamber (AC) [1, 2]. A slit-lamp examination of the left eye revealed inferior-nasal iridoschisis, which presented from the 5 to 9 o’clock positions and had a normal AC depth (Fig. 1b). One day after the surgery on the left eye, the UCVA in that eye was 20/32, and the IOP was 16 mmHg. A slit-lamp examination showed no obvious postoperative reaction. One day after surgery on the right eye, the UCVA was 20/80 and the IOP was 10 mmHg. Slit-lamp biomicroscopy showed moderate corneal oedema, an AC of normal depth, and some fibrillary materials. A slit-lamp examination of the right eye revealed inferior-nasal iridoschisis that was presented from the 4 to 6 o’clock positions and had an AC of normal depth (Fig. 2a). The patient was advised to have frequent ophthalmologic examinations to monitor the IOPs in his eyes and to assess any progression of glaucomatous changes in both eyes

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