A 76-year-old woman was referred to our hospital from one of our associated hospitals for a 1-month history of worsening vision and corneal oedema in the right eye. She had undergone laser iridotomy (LI) in both eyes at another hospital 9 months ago. She experienced progressive vision loss since a month before the referral.\nHer initial best-corrected visual acuity (BCVA) was 20/600 in the right eye and 20/30 in the left. Intraocular pressure was 10 mm Hg in both the eyes. Slit lamp examination revealed iridoschisis in both eyes. Corneal stromal oedema and Descemet's fold were more severe in the right eye than in the left (Fig. ). LI holes and moderate nuclear cataract were observed in both eyes. Endothelial cell density was 1,197 cells/mm2 in the left eye and immeasurable in the right. Iridoschisis was observed prominently in the inferior region of both eyes; the ITC index in the right and left eye was 23.6 and 24.4%, respectively.\nCataract surgery, followed by DSAEK, was planned for the right eye. Uncomplicated cataract surgery was performed with phacoemulsification and intraocular lens implantation. A twin light chandelier endoilluminator was used during surgery to support visibility [, ]; no other specialized techniques were performed besides routine cataract surgery. The ITC index in the right eye after cataract surgery was 4.7%. Subsequently, DSAEK was performed 2 weeks after cataract surgery using a pre-cut imported donor, with the pull-through technique using a Busin glide (Moria, Antony, France) and forceps (Moria USA, Doylestown, PA, USA), through a 5-mm temporal corneal incision with Descemet stripping after peripheral iridotomy. The patient's corneal oedema was treated and the BCVA at the third postoperative month was 20/25 (Fig. ). The ITC index was 0 after DSAEK.\nCorneal oedema of the left eye progressed, and the BCVA worsened to 20/50 1 year after surgery of the right eye (Fig. ). Therefore, the same surgeries were planned for the left. Cataract surgery for the left eye was performed without an endoilluminator because the stromal oedema in the left eye was not as severe as it was in the right eye. The ITC index became 6.9% after cataract surgery. Subsequently, the DSAEK was performed 1 month after cataract surgery. Her corneal oedema was treated, and the BCVA at the second postoperative month was 20/25 (Fig. ). Her ITC index was 0 after DSAEK. The AS-OCT images throughout the surgeries are shown in Figure . The changes in the ITC index are summarized in Table .
A 55-year-old female presented with BCVA of 6/18 in RE and 6/24 in LE. IOP was 18 and 20 mmHg, respectively. AC was shallow in both eyes with Relative Afferent Pupillary Defect in LE. Iridoschisis fibrils were seen from 3 to 5 o'clock position in RE and 4–8 o'clock position in LE. Gonioscopy showed 360° PAS in LE with occludable angles in RE. Lens showed nuclear sclerosis Grade 3 in both eyes with a cup-disc ratio of 0.5:1 and 0.9:1 with no rim >180° in RE and LE, respectively. She also has dot blot hemorrhages in all quadrants with macular edema in LE. She was diagnosed as a case of bilateral iridoschisis with unilateral advanced angle closure glaucoma and central retinal vein occlusion in LE and primary angle closure suspect in the fellow eye. She underwent phacotrabeculectomy with mitomycin C with intraocular lens (IOL) implantation following intravitreal avastin in LE. Laser PI was done in RE. She had an IOP of 12 and 10 mmHg on her 6th-month follow-up in RE and LE, respectively. The iris tissue from the iridoschisis site as well as the iridectomy site was sent for histopathology evaluation which showed collagen fibrils were disproportionately less obvious throughout the stroma with chronic nonspecific inflammatory cells in the iridoschisis iris tissue stroma as compared to the iridectomy iris tissue [Figure and ].