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      Iridotrabecular and Iridocorneal Contact Changes after Cataract Surgery and Endothelial Keratoplasty in Bilateral Iridoschisis

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          We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

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          Most cited references 13

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          Argon laser iridotomy-induced bullous keratopathy a growing problem in Japan.

          To describe the long-term risk of bullous keratopathy following argon laser iridotomy (ALI) in Japan and to compare it with other centres in the world. We retrospectively reviewed the case records of all patients with ALI-induced bullous keratopathy that underwent penetrating keratoplasty at Kyoto Prefectural University of Medicine (KPUM) from January 2001 to December 2004. The results were compared with the other representative centres in Singapore and the UK. Thirty-nine eyes of 33 patients were included in the study. The mean age of patients was 73.3+/-6.9 years (range, 58 to 87 years). Patients developed bullous keratopathy at a mean duration of 6.9+/-4.9 years (range, 0.2 to 16 years) after the laser iridotomy procedure. The majority of eyes that developed bullous keratopathy (59.0%) occurred following prophylactic ALI. KPUM had the highest percentage of ALI-induced bullous keratopathy cases that underwent penetrating keratoplasties, as compared with other centres in Singapore and the UK (20.0%, 1.8% and 0%, respectively). Bullous keratopathy may arise many years following ALI, and is a growing problem in Asian countries. This condition is a major cause of ocular morbidity in Japan, which has seen a worrying increase in the number of cases in recent years.
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            Twin lights: a new chandelier illumination for bimanual surgery.

             Claus Eckardt (2003)
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                Author and article information

                Case Reports in Ophthalmology
                S. Karger AG
                January - April 2021
                12 April 2021
                : 12
                : 1
                : 198-203
                aDepartment of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
                bTokyo Teishin Hospital, Tokyo, Japan
                cJR Tokyo General Hospital, Tokyo, Japan
                dDepartment of Ophthalmology, International University of Health and Welfare, Chiba, Japan
                eDepartment of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
                513793 Case Rep Ophthalmol 2021;12:198–203
                © 2021 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 1, Pages: 6
                Case Report


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