Iridocorneal syndrome: causes, symptoms, diagnosis, treatment

Iridocorneal syndrome is a group of secondary occlusal glaucomas with symptoms of angle blockade. This syndrome includes the following pathologies:

• essential atrophy of the iris;
• Chandler's syndrome (Chandler);
• syndrome of Kogan-Reese (nevus iris.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology of Iridocorneal Syndrome

Iridocorneal syndrome is rare, the exact prevalence is unknown. Typically, the disease is typical for middle-aged women, with the defeat of one eye.

[8], [9], [10], [11], [12]

Pathophysiology of iridocorneal syndrome

In three diseases of iridocorneal syndrome, one pathophysiological mechanism of development. Endothelium of the cornea abnormally sprouts through the angle of the anterior chamber and covers the surface of the iris, which gives the iris characteristic features. At first, the angle of the front camera is open, but blocked. Over time, the endothelial membrane contracts, closing the angle again and deforming the pupil and iris.

Symptoms of Iridocorneal Syndrome

In the early stages of the disease, there are no symptoms in patients. Later, patients noted a decrease in the vision of one eye and an abnormal appearance of the iris. As the intraocular pressure rises, the patient complains of pain and / or redness of the eye.

Diagnosis of iridocorneal syndrome

Biomicroscopy

On one eye, the endothelial layer of the cornea looks like a thin layer of wrought iron.

Note some anomalies of the iris, more specific for each individual disease.

• Essential atrophy of the iris: visible areas of thinning, a dystopic and deformed pupil, appearing as the endothelial membrane contracts, which contracts the iris.
• Chandler's syndrome: the changes in the iris are almost identical to those of the essential atrophy of the iris, but marked corneal edema and more noticeable changes in the cornea.
• Kogan-Reese syndrome: the iris has a flattened appearance with small nodules in normal iris tissue protruding from the holes in the endothelial layer, which gives it the appearance of "spots on the mushrooms".

Gonioscopy

At an early stage of the disease, gonioscopy of the anterior chamber angle does not reveal pathologies. Later, wide and uneven peripheral anterior sinuxes block part of the angle or the entire angle.

Rear Pole

The posterior pole is not changed, except for a certain degree of glaucomatous excavation of the optic nerve disc when the stem of the triglysis pressure rises.

[13], [14], [15], [16], [17], [18]

Treatment of Iridocorneal Syndrome

With the help of drug therapy, intraocular pressure can not be controlled, surgical intervention is necessary. The following operations are performed: trabeculectomy with the use of an antimetabolic drug, drainage implantation and cyclodestructive procedures. With a significant decrease in vision due to corneal edema, keratoplasty is performed.