G Iaccarino1, R Forte, G Cennamo. 1. Service d'Ophtalmologie, Seconda Università, Naples, Italie. raifor@hotmail.com
Abstract
INTRODUCTION: Iridoschisis is a rare condition where a localized area of iris stroma is cleaved in two, with the anterior atrophic portion disintegrating into fibrils. It is frequently associated with angle closure glaucoma and with cataract. CASE REPORT: A 70-year-old male presented with reduction of visual acuity in the left eye. Visual acuity was 20/25 OD and 20/70 OS. He had suffered acute angle-closure glaucoma in the right eye 10 years before, treated with laser iridotomy and topical antiglaucomatous therapy. Intraocular pressure was 12 mmHg OD and 46 mmHg OS. Slit lamp biomicroscopic examination revealed bilateral shallow anterior chamber, iris atrophy, and leaf degeneration of the iris stroma. A-scan and B-scan standardized echography in both eyes showed shortening of the anterior chamber, a thickened and more anteriorly located lens, the presence of a few hyperechogeneous flocculated masses floating in the vitreous, and optic disc excavation. CONCLUSION: The mechanism by which iridoschisis causes angle closure is unclear. A pupillary block could be favored by the thickening and anteriorization of the lens and the ciliary processes. Both the presence of strings of iris stroma occluding the trabecula and pupillary block could cause an elevation in intraocular pressure.
INTRODUCTION: Iridoschisis is a rare condition where a localized area of iris stroma is cleaved in two, with the anterior atrophic portion disintegrating into fibrils. It is frequently associated with angle closure glaucoma and with cataract. CASE REPORT: A 70-year-old male presented with reduction of visual acuity in the left eye. Visual acuity was 20/25 OD and 20/70 OS. He had suffered acute angle-closure glaucoma in the right eye 10 years before, treated with laser iridotomy and topical antiglaucomatous therapy. Intraocular pressure was 12 mmHg OD and 46 mmHg OS. Slit lamp biomicroscopic examination revealed bilateral shallow anterior chamber, iris atrophy, and leaf degeneration of the iris stroma. A-scan and B-scan standardized echography in both eyes showed shortening of the anterior chamber, a thickened and more anteriorly located lens, the presence of a few hyperechogeneous flocculated masses floating in the vitreous, and optic disc excavation. CONCLUSION: The mechanism by which iridoschisis causes angle closure is unclear. A pupillary block could be favored by the thickening and anteriorization of the lens and the ciliary processes. Both the presence of strings of iris stroma occluding the trabecula and pupillary block could cause an elevation in intraocular pressure.