Omoto Takashi, Agata Chisato, Akiyama Reina, Kitamoto Kohdai, Toyono Tetsuya, Yoshida Junko, Yamagami Satoru, Usui Tomohiko, Miyai Takashi
Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Tokyo Teishin Hospital, Tokyo, Japan.
Case Rep Ophthalmol. 2021 Apr 12;12(1):198-203. doi: 10.1159/000513793. eCollection 2021 Jan-Apr.
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.
我们报告一例伴有角膜水肿的双侧虹膜劈裂症病例，并对白内障手术前后以及深板层角膜内皮移植术（DSAEK）后虹膜小梁和虹膜角膜接触的变化进行了定量评估。一名76岁患有虹膜劈裂症和白内障的女性，此前接受过激光虹膜切开术治疗，视力逐渐下降。通过眼前节光学相干断层扫描测量的术前虹膜小梁接触（ITC）指数，右眼为23.6%，左眼为24.4%。右眼术前角膜水肿比左眼更严重。右眼先进行了白内障手术，随后进行了DSAEK，左眼随后也进行了相同手术。术后她的视力得到改善，双眼角膜水肿均得到成功治疗。此外，双眼的ITC指数均有所改善，右眼白内障手术后为4.7%，DSAEK后为0%；左眼白内障手术后为6.9%，DSAEK后为0%。分期白内障手术和DSAEK对虹膜劈裂症引起的内皮失代偿有效。此外，我们证实，不仅白内障手术后，而且DSAEK后，两种手术操作后虹膜小梁和虹膜角膜接触均得到改善。本病例报告显示了ITC指数在检测不同手术操作后变化方面的临床实用性。
