Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Jan 5:9:34-37.
doi: 10.1016/j.ajoc.2018.01.010. eCollection 2018 Mar.

Descemet membrane endothelial keratoplasty for corneal decompensation due to iridoschisis

Miles F Greenwald  1 , Philip I Niles  1 , A Tim Johnson  1 , Jesse M Vislisel  1 , Mark A Greiner  1   2
Affiliations
Case Reports

Descemet membrane endothelial keratoplasty for corneal decompensation due to iridoschisis

Miles F Greenwald et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To 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).

Observations: A 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 importance: DMEK can be performed safely and successfully after staged cataract surgery with superficial iridectomy in eyes with endothelial decompensation caused by iridoschisis.

Keywords: Corneal edema; Descemet membrane endothelial keratoplasty; Diabetes mellitus; Iridoschisis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Slit lamp photos and Scheimpflug corneal imaging of the right eye demonstrate corneal decompensation due to iridoschisis at the time of initial presentation (A–C), and restored corneal anatomy one month (D–F) and one year (G–I) following Descemet membrane endothelial keratoplasty (DMEK). Preoperative iris degeneration and corneal changes were most prominent in the inferior quadrant (A–C). Resolution of corneal edema and removal of free-floating iris fibrils by iridectomy, performed with cataract surgery one month prior to DMEK surgery, is visible on postoperative slit lamp examination (D-E, G-H). Normalization of corneal pachymetry (μm) was achieved by one month after DMEK (F) and corneal thickness remained stable through one year postoperatively (I).
Fig. 2
Fig. 2
Anterior segment optical coherence tomography of the right eye at presentation. Evidence of separation of the anterior iris stromal layer, and contact of iris fibrils with the posterior cornea, are present in the inferior quadrant (A, right side of image 315°) extending into the nasal quadrant (B, right side of image 0°).
See this image and copyright information in PMC

References

    1. Flanary W.E., Vislisel J.M., Wagoner M.D. Incidence of cystoid macular edema after Descemet membrane endothelial keratoplasty as a staged and solitary procedure. Cornea. 2016;35(8):1040–1044. - PubMed
    1. Gogaki E., Tsolaki F., Tiganita S., Skatharoudi C., Balatsoukas D. Iridoschisis: case report and review of the literature. Clin Ophthalmol. 2011;5:381–384. - PMC - PubMed
    1. Srinivasan S., Batterbury M., Hiscott P. Bullous keratopathy and corneal decompensation secondary to iridoschisis: a clinicopathological report. Cornea. 2005;24(7):867–869. - PubMed
    1. Wang H.B., Hu Y.X., Feng X. Corneal endothelial decompensation secondary to iridoschisis in degenerative myopic eyes: a case report. Int J Ophthalmol. 2012;5:116–118. - PMC - PubMed
    1. Danias J., Aslanides I.M., Eichenbaum J.W., Silverman R.H., Reinstein D.Z., Coleman D.J. Iridoschisis: high frequency ultrasound imaging. Evidence for a genetic defect? Br J Ophthalmol. 1996;80:1063–1067. - PMC - PubMed

Publication types

LinkOut - more resources