Iridocorneal Endothelial Syndrome Management is tough but Never Impossible. A Case Series Study

Purpose: To document and describe clinical manifestations and management approaches to patients diagnosed with Iridocorneal Endothelial (ICE) syndrome presenting at the Glaucoma Department, Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh. Design: A hospital-based prospective observational case series review. Participants: 25 patients who were diagnosed as ICE syndrome from November 2007 to October 2009. Method: Patient particulars, history with main causes of hospital presentations were recorded. Ophthalmic examination details including tonometry, slit lamp examination, gonioscopy, indirect ophthalmoscopy, visual fluid examination and management given were documented. Similar relevant details were recorded for three follow up periods on all patients extending over a total period of 12 months. Main outcome measure: Significant observations, pattern or associations within the cohort. Results: 25 patients were included in the study. There were 15 female and 10 male patients. All 25 cases were unilateral. The mean age of the patients was 41 ± 15.27 years. Among them 15(60%) had pre-treatment visual acuity between 6/9 – 6/18 and 10(40%) had 6/24 – 6/60). Improved visual acuity was observed one year after starting treatment. 21 patients (84%) presented with eccentric pupil (corectopia), 9 patients (36%) with peripheral anterior synechiae, 6 patients (32%) with iris atrophy, 6 patients (24%) with mild corneal oedema, 3 patients (12%) with ectropion uveae, 2 patients (8%) with polyconic and 11 patients (44%) presented with pigmentary changes over iris (like diffuse iris naevus). Mean IOP at presentation was 24.08 ±14.3 mmHg and that of last follow-up was 17.38 ± 7.57 mmHg. IOP was controlled with 2 – 3 topical anti glaucoma medications in 8 patients (32%); with only observation in 5 patients (20%) and with surgical intervention in 12 patients (48%). Conclusion: Although ICE syndrome is a refractory glaucoma, control of Intraocular Pressure (IOP) and preservation of visual acuity were seen in 52% of cases which had conservative management with topical medications and observation. Patients not responding to medical management needed surgery for the control of intraocular pressure.