Long-term outcome of aqueous shunt surgery in ten patients with iridocorneal endothelial syndrome

doi:10.1016/S0161-6420(99)00529-1

Ophthalmology

Volume 106, Issue 5, 1 May 1999, Pages 1030-1034

https://doi.org/10.1016/S0161-6420(99)00529-1 Get rights and content

Abstract

Purpose

To report the long-term outcome of ten patients with iridocorneal endothelial (ICE) syndrome who underwent aqueous shunt surgery for uncontrolled glaucoma.

Design

Noncomparative, retrospective case series.

Participants

The authors reviewed charts of ten patients with ICE syndrome-related glaucoma who underwent aqueous shunt surgery at one institution between 1987 and 1996.

Main outcome measures

Intraocular pressure (IOP), number of glaucoma medications, and further surgical interventions were measured.

Results

With a median follow-up of 55 months, four eyes had adequate IOP control (IOP < 21 mmHg) with one or two medications after the initial aqueous shunt surgery. An additional three eyes achieved adequate IOP control after one or more tube repositionings or revisions of the initial aqueous shunt. In this series, the aqueous shunt surgery most often failed because of blocking of the tube ostium by iris, ICE membrane, or membrane-induced tube migration.

Conclusion

Aqueous shunt surgery appears to be an effective method for IOP lowering in some eyes with ICE syndrome-related glaucoma when medical treatment or conventional filtration surgeries fail, but additional glaucoma procedures and/or aqueous shunt revisions and tube repositionings are not uncommon.

Section snippets

Materials and methods

We reviewed the charts of ten patients with ICE syndrome-related glaucoma who underwent aqueous shunt surgery by a member of the Glaucoma Service of Wills Eye Hospital between 1987 and 1996.

Complete success was defined as a postoperative intraocular pressure (IOP) of 21 mmHg or lower, with or without glaucoma medications, for the entire course of available follow-up. Qualified success was defined as IOP of 21 mmHg or lower, with or without medications, at most recent follow-up in eyes that had

Results

The clinical characteristics of the ten patients are summarized in Table 1. All ten patients were female. The mean age, mean preoperative IOP, and median number of preoperative glaucoma medications were 44.2 ± 13.3 years, 37.1 ± 11.5 mmHg, and 2.6 ± 0.7 medications, respectively. Baseline visual acuity ranged from 20/20 to hand motion (median = 20/65). All eyes were phakic. Eight of the ten eyes had undergone previous trabeculectomy, six of which were supplemented with 5-fluorouracil (5-FU).

Discussion

Aqueous shunt surgery is usually performed when conventional filtration surgeries fail or are expected to fail. Patients with ICE syndrome undergoing filtering procedures are believed to have a lower success rate than do patients with most other types of glaucoma.11 Laganowski et al5 reported that glaucoma occurred in 33 (50%) of 66 patients with the ICE syndrome. Of the 25 patients with glaucoma whose detailed records were reviewed, 22 required surgical intervention. Twenty of 22 patients had

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Cited by (43)

Ex-PRESS shunt combined with ab-interno peripheral iridectomy: A new surgical procedure for iridocorneal endothelial syndrome
2023, American Journal of Ophthalmology Case Reports
Iridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle. Filtration surgeries are often required but are associated with a higher rate of surgical failure or complications than other types of glaucoma. Herein, we report a new and effective surgical procedure for glaucoma secondary to ICE syndrome: Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter.
Three patients with ICE syndrome who underwent surgery were included. Intraoperatively, an ab-interno peripheral iridectomy was performed using a small-gauge vitreous cutter through a corneal incision in the superior-nasal or superior-temporal quadrants to create space for the insertion of Ex-PRESS shunt free from the iris tissue. The shunt was inserted under the scleral flap. The first patient underwent combined cataract surgery, whereas patients 2 (pseudophakia) and 3 (phakia) underwent Ex-PRESS alone.
No intraoperative complications were observed. The intraocular pressure remained stable until the final postoperative visits at approximately 7, 4, and 1 year in Cases 1, 2, and 3, respectively. Case 2, with mild preoperative corneal edema due to graft failure in Descemet's stripping automated endothelial keratoplasty (DSAEK), underwent reDSAEK 6 months postoperatively.
Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter may be a safe and effective surgical procedure in patients with ICE syndrome, regardless of the lens status.
Eye-on-a-chip
2023, Principles of Human Organs-on-Chips
Achieving Inner Aqueous Drain in Glaucoma Secondary to Iridocorneal Endothelial Syndrome: One Year Results of Penetrating Canaloplasty: Bleb Independent Anti-Glaucoma Surgery in ICE
2022, American Journal of Ophthalmology
Citation Excerpt :
Doe and associates reported a cumulative survival of 73%, 44%, and 29% for antifibrotic augmented trabeculectomy and 71%, 71%, and 53% for GDI in GS-ICE at 1, 3, and 5 years, respectively.9 In the study by Kim and associates, the aqueous shunt survival at 1, 3, and 5 years was 70%, 40%, and 40%.11 Most recently, Gebremichael and associates23 and Mao and associates24 reported higher GDI survival in 2 independent studies (92.3 ± 7.4%, 66.1 ± 11.0%, and 50.5% ± 17.3% at 1, 3, and 4 years, respectively and 94.4%, 88.1%, and 73.5% at 1, 2, and 3 years, respectively).
To report the efficacy of a bleb-independent penetrating canaloplasty in the management of glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE).
Prospective, non-comparative clinical study.
Penetrating canaloplasty was performed on 35 eyes from 35 patients with GS-ICE and medically uncontrolled intraocular pressure (IOP) between January 2018 and April 2020. Patients were followed up at 1 week, months 1, 3, 6, 12 postoperatively, and semi-annually thereafter. The IOP, anti-glaucoma medication, and surgery-related complications were recorded. Surgical success was defined as IOP ≥ 5 mmHg and ≤ 21 mmHg without (complete success) or with/without (qualified success) IOP-lowering medication.
A total of 29 eyes (82.9%) had 360° catheterization and successfully received penetrating canaloplasty. Of these eyes, 24 (82.8%) achieved qualified success and 22 (75.9%) achieved qualified success at 12 months after surgery. The mean IOP decreased from 39.5 ± 11.8 mmHg on 2.9 ± 1.0 medications before surgery to 16.6 ± 5.3 mmHg (P < .001) on 0.2 ± 0.6 medications (P < .001) at 12 months postoperatively, respectively. Hyphema (37.9%), transient hypotony (34.5%), and transient postoperative IOP elevation (≥ 30 mmHg, 17.9%) were the most commonly observed early complications at the 1 week and 1 month visits. From 1 month and beyond, all treated eyes showed no obvious bleb at the operation quadrant.
Penetrating canaloplasty rescued the inner aqueous outflow in ICE eyes and demonstrated acceptable success in IOP control with few complications, providing a new option for the management of GS-ICE.
Etiological mechanism of iridocorneal endothelial (ICE) syndrome may involve infection of herpes simplex virus (HSV) and integration of viral genes into human genome
2018, Medical Hypotheses
Iridocorneal (ICE) syndrome is a rare ocular disease characterized by abnormal proliferation of corneal endothelial cells, progressive obstruction of irido-corneal angle and atrophy of iris. ICE syndrome progressed slowly, but can cause serious complications such as secondary glaucoma in late stage. Because the etiology of ICE syndrome is not clear, there is still no effective treatment in clinical practice. Previous studies have detected herpes simplex virus (HSV) DNA inside patient’s aqueous humor. However, no further explanation for HSV-related etiology of ICE syndrome was established. Besides, construction of animal models using HSV all failed, leaving behind a blank space about how HSV infection finally led to ICE syndrome. By summarizing findings from previous studies, we came up with a hypothesis about etiology of ICE syndrome: HSV infection initiated ICE syndrome by integration of viral genetic material into human genome. Infection of HSV changed activity and morphology of endothelial cells, making them regain the ability of mitosis. Proof of such hypothesis will provide a theoretical foundation for construction of animal models and effective intervention of the disease.
Graft failure and intraocular pressure control after keratoplasty in iridocorneal endothelial syndrome
2015, American Journal of Ophthalmology
Citation Excerpt :
There are a few small published studies on outcomes of secondary glaucoma in ICE patients since the introduction of antifibrotic agents and GDD surgery. These studies found reasonable success rates for trabeculectomy with antifibrotic agent application40,41 and GDD in cases that have failed medical treatment or conventional filtration surgery.42 Although essential iris atrophy has been reported to develop a more severe form of glaucoma compared to those with Chandler syndrome,9 there was no difference in the need for additional IOP-lowering therapy between these 2 subgroups in our study.
To describe and compare graft survival and intraocular pressure (IOP) control after penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with iridocorneal endothelial (ICE) syndrome.
Retrospective case series.
Multicenter study conducted at the Singapore National Eye Centre (SNEC) and Price Vision Group. Twenty-nine consecutive eyes with ICE syndrome that underwent keratoplasty between 1991 and 2011 were identified from the SNEC transplant database and Price Vision Group patient database and the following data extracted: demographics, graft failure, IOP indices, and glaucoma treatment pre- and postkeratoplasty. The main outcome measures were graft failure and need for additional IOP-lowering treatment after keratoplasty.
The mean follow-up duration was 7.0 ± 4.9 years in the PK group (n = 17) and 4.0 ± 2.6 years in the DSAEK group (n = 12). After a mean of 4.1 ± 3.1 years, 37.9% of grafts (11/29) failed: 7 PK compared to 4 DSAEK (P = .72). The graft failure rate was 50% in eyes with prekeratoplasty glaucoma surgery vs 31.6% in those without (P = .43). Additional glaucoma treatment was required in 37.9% of eyes (11/29): 41.2% of PK eyes and 50% of DSAEK eyes (P = .28) Eyes that had undergone glaucoma surgery before keratoplasty were less likely to require escalation of IOP-lowering therapy postkeratoplasty (9.1% vs 50%, P = .03).
One-third of grafts failed after keratoplasty for ICE syndrome at a mean duration of 4 years and additional IOP-lowering treatment was required in 37.9%. Both PK and DSAEK had similar outcomes with regard to graft failure and IOP control.
The iridocorneal endothelial syndrome
2018, Survey of Ophthalmology
Citation Excerpt :
In pseudophakic eyes, we advocate for tube insertion through the ciliary sulcus, which decreases the risk of corneal decompensation by tube-cornea touch (especially in eyes with compromised corneal endothelium, which is quite common in ICE syndrome) and also decreases the risk of iris damage or iris dialysis in eyes with important PAS (also common in ICE syndrome, especially PIA or CRS). Placement of the tube behind the iris could also potentially prevent obstruction of the lumen by ICE membrane migrating from the iridocorneal angle, which has been previously reported.54 We trim the tube bevel down to decrease the risk of obstruction of the lumen by the posterior surface of the iris whether the tip stays ideally beyond the pupillary margin, or right behind it.
The iridocorneal endothelial syndrome represents a unique group of ocular pathologies (Chandler syndrome, progressive iris atrophy, and Cogan-Reese syndrome) characterized by the proliferation of corneal endothelial cells that migrate toward the iridocorneal angle and iris surface causing, to a degree varying according to the subtype, corneal edema and decompensation and secondary glaucoma, whether by obstructing the angle or producing peripheral anterior synechiae by contraction of the basement membrane of the migrating cells over the surface of the iris. A triggering factor, possibly viral, induces the corneal endothelial cells to proliferate and behave like epithelial cells. Diagnosis is made based on typical ocular findings on the cornea and iris. Iridocorneal endothelial syndrome is more frequent in young women, with unilateral involvement in most cases. In vivo confocal microscopy is an excellent diagnostic tool, especially in borderline presentations like early cases of Chandler syndrome, which affects the cornea predominantly. Typical clinical management consists of treating the corneal edema and decompensation, where endothelial keratoplasty techniques have replaced in many cases the need for a penetrating keratoplasty and treating the secondary glaucoma, which usually requires surgical intervention.

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^☆: Supported in part by the Glaucoma Service Foundation to Prevent Blindness, Philadelphia, Pennsylvania.

¹: The authors have no proprietary interest in any of the materials used in this study.

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Long-term outcome of aqueous shunt surgery in ten patients with iridocorneal endothelial syndrome1Historical image☆,

Abstract

Purpose

Design

Participants

Main outcome measures

Results

Conclusion

Section snippets

Materials and methods

Results

Discussion

Surv Ophthalmol

Am J Ophthalmol

Surv Ophthalmol

Ophthalmology

Proliferative endotheliopathy with iris abnormalities. The iridocorneal endothelial syndrome

Arch Ophthalmol

Pathogenesis of Chandler’s syndrome, essential iris atrophy and the Cogan-Reese syndrome. I. Alterations of the corneal endothelium

Invest Ophthalmol Vis Sci

Long-term outcome of aqueous shunt surgery in ten patients with iridocorneal endothelial syndrome¹Historical image☆,