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.
An 85-year-old male presented with unilateral inferior iridoschisis with cataract and underwent phacoemulsification with PCIOL- Posterior chamber intraocular lens implantation. He had an IOP of 14 mm in both eyes with open angles on gonioscopy and a disc with a cup-disc ratio of 0.4:1 in both eyes. The contralateral eye was pseudophakic.