2024年 · 第104卷第24期

The patient, 80 years old, went to the glaucoma clinic of Beijing Tongren Hospital affiliated to Capital Medical University because of "blurred vision in his left eye for more than half a year". The patient experienced visual acuity decrease in the left eye more than half a year before the visit, and the intraocular pressure reached a maximum of 42 mmHg (1 mmHg =0.133 kPa), and the left eye was treated with latanoprost spot. Lost blindness from right eye trauma for 32 years. Visual acuity: no light sensation in right eye, 0.1 in left eye; Intraocular pressure: T-1 in right eye (slight decrease in intraocular pressure, digital measurement), 19 mmHg in left eye. Slit lamp examination showed that the cornea of the right eye was opaque and the remaining structure was unclear. The left eye has slight conjunctival hyperemia, clear cornea, shallow anterior chamber, and lower peripheral anterior chamber is shallower than upper; The iris matrix is loose, especially the lower part. At 4: 00~7: 00, the iris matrix tissue is separated between layers, the superficial tissue is broken, and the loose split tissue of the iris floats in the anterior chamber (Figure 1). After illumination, the lower and 12:00 iris transmission was clearly visible (Figure 2). The pupil is round, approximately 5 mm in diameter, obtuse to light reflection, and the lens is opaque. Fundus: The disc edge of the left eye is obviously narrowed, with a cup-to-disc ratio of about 0.9, and diffuse retinal nerve fiber layer defect. Gonioscopy: Only the Schwalbe line is seen in both static and dynamic, and the angle of the chamber is closed around the whole circumference. Diagnosis: "Iridoschisis in left eye, secondary angle-closure glaucoma in left eye, cataract in left eye". Iridoschisis is a relatively rare disease, usually occurring in the elderly, mostly in both eyes, but the disease can be seen in one eye in the early stage. There is a certain genetic susceptibility to this disease, but it can also be seen in sporadic cases, or secondary to ocular trauma, syphilis, etc. About 2/3 of iridoschisis can be combined with different types of glaucoma, and its relationship with glaucoma and its role in the mechanism of glaucoma are still controversial. The cause of secondary glaucoma in this patient is related to narrow and closed chamber angle. Irischisis is iris fibrosis and atrophy leading to separation of the anterior and posterior stromal layers of the iris. The typical feature is separation of the iris stromal layer and rupture, and loose sheet-like and cord-like split tissue of the iris floats in the anterior chamber, which may be accompanied by a decrease in the number of corneal endothelial cells. This patient had typical iris manifestations and the diagnosis was clear.