Case 1 involved a 69-year-old male who presented with one month of blurred vision and an exacerbation of this blurred vision for the preceding ten days in the right eye (OD). The patient had no history of ocular trauma or heritable ocular disease. He had been suffering from hypertension for 15 years and was receiving antihypertensive treatment.\nThe result of a rapid plasma reagin (RPR) test for syphilis was negative. A clinical examination showed that the preoperative uncorrected visual acuities (UCVA) were hand movement OD and 20/40 for the left eye (OS). The IOP in each eye was 13 mmHg. Slit-lamp biomicroscopy showed that the anterior layer of the iris stroma (OD) was divided into a loose mixture of numerous pigmented and white atrophic strands, which ran in all directions and thus presented an interlaced pattern. The distal ends of the fibrils were attached to the ciliary portion and were floating freely in the aqueous humour (Fig. ). The underlying iris pigment epithelium appeared imperfect, which indicated the transillumination defect, and the exfoliating iris pigment epithelium accumulating in the AC could also be observed. The right eye showed a mature cataract that hindered visualization of the fundus and evaluation of any optic disc alterations. 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. ). Scheimpflug image by Sirius (Costruzione Strumenti Oftalmici, Florence, Italy) showed that the local AC was extremely shallow in the right eye (Figs. ). The endothelial cell counts were 3,453 cells/mm2 OD and 3,738 cells/mm2 OS.\nPhacoemulsification (PHACO) was first performed on the right eye and was then conducted on the left eye one month later. During surgery, the freely floating iris fibrils were cut with Vannas capsulotomy scissors. A foldable hydrophobic acrylic IQ intraocular lens (IOL) (Acry-Sof® SN60WF, Alcon Laboratories Inc.) was safely implanted in the capsular bag. Postoperative examinations were conducted at 1, 7, 30, and 60 days following the procedure.\nOne day after the surgery on the right eye, the UCVA of the right eye was FC/30 cm, and the IOP was 13 mmHg. A slit-lamp examination showed moderate ocular hyperaemia and corneal oedema. The AC depth was normal, and the pupil was round and undamaged. One week after surgery, the UCVA was 20/50 and the IOP was 15 mmHg. The ocular hyperaemia had disappeared, and there was mild corneal oedema that was improving. One month after surgery, the UCVA was 20/40 and the IOP was 17 mmHg (Fig. ). Two months after surgery, the UCVA was 20/30, the IOP was 17 mmHg, and the endothelial cell count was 1,085 cells/mm2.\nOne month after the surgery on the right eye, PHACO was performed on the left eye without additional treatment to the iris. 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 week after surgery, the UCVA was 20/30 and the IOP was 17 mmHg. One month after surgery, the UCVA was 20/25 and the IOP was 16 mmHg (Fig. ). The endothelial cell count was 2,630 cells/mm2 at that time. Two months after surgery, the UCVA was 20/25, the IOP was 14 mmHg, and the endothelial cell count was 3,618 cells/mm2. Although the postoperative corneal endothelial cell density remains normal, the coefficient of variation > 30.
Case 2 involved an 87-year-old female who presented with blurred vision in both eyes for the preceding two years. The patient had suffered from diabetes mellitus for four years, had an allergy to penicillin, had a history of hypertension, and was on antihypertensive and antidiabetic treatments. She had received cataract surgery on her left eye two years earlier and had no history of ocular trauma or heritable ocular disease.\nThe result of a RPR test for syphilis was negative. A clinical examination showed that the preoperative best corrected visual acuities (BCVAs) were 20/200 OD and 20/200 OS. The IOPs were 12 mmHg OD and 10 mmHg OS. Slit-lamp biomicroscopy of the right eye showed a “shredded-wheat” appearance in the nasal quadrants (from the 4 to 6 o’clock positions). The pupil of this eye was round and had a normal reaction to light. The lens showed a mature cataract, which hindered visualization of the fundus and evaluation of any optic disc alterations. The AC was normal, and the angle was open. The endothelial cell count was 3,068 cells/mm2. Slit-lamp biomicroscopy of the left eye showed iris atrophy in the inferior temporal quadrants (Fig. ). The IOL of the left eye was in position. Because the patient in Case 2 had a right eye that was similar to the left eye of the patient in Case 1 and considering the limited extent of the iridoschisis, conventional PHACO was performed on the patient in Case 2 to remove the cataract, and a single-piece acrylic intraocular lens (Zeiss® CT SPHERIS 209 M, Zeiss) of 16.0 D was then safely implanted in the capsular bag.\nOne 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. The pupil was round and undamaged. One week after surgery, the UCVA was 20/63 and the IOP was 13 mmHg. The ocular hyperaemia had disappeared and the mild corneal oedema was improving. One month after surgery, the UCVA was 20/50 and the IOP was 13 mmHg. The endothelial cell count was 1,456 cells/mm2. 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. ).