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 ].
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.