Case 3 involved a 66-year-old male who was referred to our clinic because of visual loss with congestion and intermittent pain in the left eye for the preceding six months. The patient had no history of ocular trauma or heritable ocular disease.\nThe result of a RPR test for syphilis was confirmed to be a false positive. The preoperative BCVAs were 20/125 OD and 20/50 OS. The IOPs were 22 mmHg OD and 35 mmHg OS. Slit-lamp examination revealed a local rupture in the temporal quadrant of the iris stroma of the right eye (Fig. ). In the left eye, the anterior layer was divided into a loose mixture in the temporal iris and the AC was of normal depth (Fig. ). A postmydriatic examination showed cortical opacity of the lens and dust turbidity of the vitreous body. Gonioscopy showed that the peripheral AC in the superior area of the right eye had a discontinuous synechia along together with pigment deposition (Fig. ). Scheimpflug images by Sirius showed that part of the peripheral AC was shallow and that the iridocorneal angle was still open in both eyes (Figs. ). The endothelial cell counts were 3,306 cells/mm2 OD and 3,011 cells/mm2 OS. The patient was diagnosed with secondary glaucoma with iridoschisis and received BAK-free travoprost 0.004% containing polyquaternium-1 (Travatan® preserved with POLYQUAD®, Alcon Laboratories, Fort Worth, TX, USA) once daily and brinzolamide (Azopt®, Alcon, Laboratories, Elkridge, MD), 2% carteolol (Mikelan®, China Dazhong pharmaceutical Co., Ltd, Tianjin, China), and alpha2-agonist (Alphagan®, Allergan, Inc., Irvine, CA) twice daily.\nOne month after admission, over which time the eye drops were used, the IOPs were 18 mmHg OD and 32 mmHg OS. The IOPs showed significant fluctuation with medical treatment. Notably, glaucoma surgery will be necessary for this patient in the future. The patient was advised to have frequent ophthalmologic examinations to monitor the IOPs in his eyes and to assess any progression of glaucomatous changes in both eyes.
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. ).