Saleki Mohammad, Lee Preston, Thaung Caroline, Ashena Zahra
Queen's Hospital, Romford, London, UK.
Department of Medicine, Queen Mary University of London, London, UK.
Ther Adv Ophthalmol. 2025 Aug 18;17:25158414251343968. doi: 10.1177/25158414251343968. eCollection 2025 Jan-Dec.
We report the first case of concurrent iridocorneal endothelial (ICE) syndrome and keratoconus, treated successfully with Descemet's membrane endothelial keratoplasty (DMEK). A 60-year-old male presented with gradual visual deterioration in his left eye over 4 years. Best corrected visual acuity was 1.1 LogMar, with corneal stromal oedema. Hypertonic saline and systemic acyclovir provided no improvement. Further examination revealed peripheral anterior synechiae and possible ICE syndrome. Combined cataract surgery and adapted DMEK were performed, using right eye data for intraocular lens calculation. Postoperative histopathology confirmed ICE syndrome. Two months postoperatively, vision improved to 0.54 LogMar, with normal intraocular pressure and optical coherence tomography. Ten months later, unaided visual acuity reached 0.4 LogMar, with no significant changes observed in regular follow-ups. The patient remains satisfied with his vision. This case highlights the rare association of keratoconus with Chandler Syndrome and the first report of such a case where DMEK was used as management. The diagnosis of ICE syndrome complicates treatment, however, despite the challenges, DMEK demonstrated promising results for ICE-related corneal oedema in a patient with concurrent keratoconus, offering improved visual acuity and no complications.
我们报告了首例并发虹膜角膜内皮（ICE）综合征和圆锥角膜的病例，通过Descemet膜内皮角膜移植术（DMEK）成功治疗。一名60岁男性在4年中左眼视力逐渐下降。最佳矫正视力为LogMar 1.1，伴有角膜基质水肿。高渗盐水和全身用阿昔洛韦治疗无效。进一步检查发现周边前粘连及可能的ICE综合征。进行了白内障联合手术及改良的DMEK手术，使用右眼数据计算人工晶状体度数。术后组织病理学证实为ICE综合征。术后两个月，视力提高到LogMar 0.54，眼压正常，光学相干断层扫描结果正常。十个月后，裸眼视力达到LogMar 0.4，定期随访未观察到明显变化。患者对视力状况满意。该病例突出了圆锥角膜与钱德勒综合征的罕见关联，以及首例使用DMEK治疗此类病例的报告。ICE综合征的诊断使治疗变得复杂，然而，尽管存在挑战，DMEK在并发圆锥角膜的患者中对ICE相关角膜水肿显示出有前景的结果，提高了视力且无并发症。
