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 ].
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.