A 60-year-old female presented with painful diminution of vision with nausea for past 2 days. On evaluation, best-corrected visual acuity (BCVA) was 6/9 in the right eye (RE) and finger counting at 2 m in the left eye (LE). IOP as measured by Goldmann Applanation Tonometry was 11 and 48 mmHg in RE and LE, respectively. Microcystic corneal edema with shallow AC was seen in LE. Multiple thin disintegrated iris fibrils were seen floating in the AC from 5 to 7 o'clock in RE and from 4 to 8 o'clock in LE [Figure and ]. Gonioscopy showed 180° and 360° peripheral anterior synechiae (PAS) in RE and LE [], respectively. Laser peripheral iridotomy (PI) was done in both eyes. Lens showed early nuclear sclerosis with a cup-disc ratio of 0.5:1 in RE and 0.6:1 with inferior rim thinning in LE. Corresponding superior arcuate defect was seen on visual fields in LE. She was diagnosed as a case of bilateral iridoschisis presenting as unilateral acute angle closure attack. A combination of two antiglaucoma medications (AGMs) was started in both eyes. On her 6-month evaluation, the patient had an IOP of 12 and 14 mmHg in RE and LE, respectively.
A 60-year-old female presented with BCVA of 6/36 and finger counting 1 m in RE and LE, respectively, with an IOP of 15 mm in both eyes. Iridoschisis was present from 4 to 5 o'clock hour in RE and pseudophakic bullous keratopathy (PBK) was seen in LE. Gonioscopy showed occludable angles in RE with nuclear sclerosis Grade 2. Fundus examination showed a cup-disc ratio of 0.4:1 in RE. She was diagnosed as a case of unilateral iridoschisis with occludable angles in RE and cataract and contralateral PBK (presence of iridoschisis could not be commented upon due to poor view due to PBK). Phacoemulsification with IOL implantation was done in RE. Postoperatively, vision was 6/9 with an IOP of 11 mm and normal visual fields. It is also a possibility that the other eye also had associated occludable angles, leading to a complicated surgery and eventually PBK.