Iridencleisis?

Abstract

A 74- year-old woman was evaluated for progressive reduction of visual acuity in her left eye (OS). She had been submitted to glaucoma surgery in both eyes (OU) 7 years ago and to cataract surgery in OS 1 and a half years ago in another Institution. Current examination showed a visual acuity of no light perception in her right eye (OD) and 1/10 in OS, intraocular pressure (IOP) of 24 mmHg in OD and 2 mmHg in OS. Biomicroscopy revealed a medium bleb OU and an inflammatory pupillary membrane OS. Fundoscopy revealed total excavation OD and OS couldn t be observed. Normal ocular ecography OU. After two successful Nd:YAG LASER removals, the pupillary membrane reappeared. It was decided to perform a surgical membranectomy. It was confirmed intraoperatively that the previous glaucoma surgery was a technique called Iridencleisis, and we used bovine pericardium to cover the existing sclerocorneal fistula, thereby creating a flap. Three weeks after the surgery the visual acuity is 8/10 OS and IOP of 8 mmHg OS. Iridencleisis consists in the surgical creation of a permanent drain by incarceration of a slip of the iris within a sclerocorneal incision to act as a wick through which the aqueous is filtered from the anterior chamber to the subconjunctival tissues. It was a popular procedure between 1907 and 1957 and was forgotten after 1968 Cairns s trabeculectomy. Surprisingly iridencleisis was the surgical procedure used in this patient and the responsible for the formation of the inflammatory membrane.