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Iridocorneal Endothelial Syndrome

ICE syndrome


Presentation

  • RESULTS: ICE syndrome was present in 223 eyes of 203 subjects, 124 (61%) were female and 79 (39%) were male. The median age at presentation was 43 years (1st (Q1) and 3rd (Q3) quartile; 34, 51 years).[ncbi.nlm.nih.gov]
  • Patients present with decreased vision, pain secondary to corneal edema or secondary angle-closure glaucoma, or an abnormal iris appearance.[aao.org]
Collapse
  • It is tentatively concluded that the appearance of the abnormal cells is a function of their three-dimensional shape and that they produce blister-like vesicles that rupture, collapse, and eventually invaginate.[ncbi.nlm.nih.gov]
  • Further, in CME caused by use of an eye drop formulation of latanoprost, a prostaglandin analog used for glaucoma [ 9 ] and CME following cataract surgery [ 11 ], inflammatory material from the anterior chamber may reach the macula and lead to collapse[bmcophthalmol.biomedcentral.com]
Hypothermia
  • Therefore, caution should be exercised since topical brimonidine given to human infants aged younger than 2 months has been reported to cause bradycardia, hypertension, hypothermia, and apnea. 72. THANK YOU[slideshare.net]
Corneal Edema
  • Therapy is directed toward the corneal edema and secondary glaucoma. Hypertonic saline solutions and medications to reduce the IOP, when elevated, can be effective in controlling the corneal edema.[aao.org]
  • Visual impairment and pain associated with corneal edema can be successfully managed with endothelial keratoplasty.[ncbi.nlm.nih.gov]
Suggestibility
  • Scanning electron microscopy showed some degenerated corneal endothelial cells with filopodial cytoplasmic projections, suggesting endothelial migration.[ncbi.nlm.nih.gov]
Confusion
  • Initially, the membrane was confused with the anterior lens capsule during extracapsular cataract extraction, leading to the performance of a pseudocapsulorrhexis.[ncbi.nlm.nih.gov]
  • D/D • Other disorders of the cornea and iris, many with associated glaucoma, can be confused with ICE syndromes. • 1.[slideshare.net]

Workup

Anisocytosis
  • The endothelial cells were relatively well preserved and exhibited marked pleomorphism, anisocytosis, and flat, occasionally paired oval nuclei. Binucleate cells also were observed.[ncbi.nlm.nih.gov]

Treatment

  • CONCLUSIONS: 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%.[ncbi.nlm.nih.gov]
  • You can help by adding to it. ( September 2017 ) Treatment [ edit ] Penetrating karatoplasty and endothelial keratoplasty can be used as treatments for severe cases of ICE [2,8].[en.wikipedia.org]
  • The exam will usually show: changes in the iris swelling of the cornea, and increased pressure in the eye (glaucoma) Treatment There is no way to stop the progression of ICE. Treatment is usually focused on managing the glaucoma.[aao.org]
  • Conclusions 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%.[basirclinic.ir]
  • The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.[orpha.net]

Prognosis

  • These changes may possibly affect the long-term prognosis of penetrating keratoplasty in an adverse fashion.[ncbi.nlm.nih.gov]
  • Prognosis is generally poor when associated with glaucoma [1,2]. References [ edit ] [1] Friedman NJ, Kaiser PK, Pineda R. (2009). The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Chapter 7: Iris and Pupils (pp. 285–287).[en.wikipedia.org]
  • @article{cd386d59f17f419eb951c2542584ba35, title "Prognosis for penetrating keratoplasty in iridocorneal endothelial syndrome", author "Chang, {P. C.T.} and Soong, {H. K.} and Couto, {M. F.} and Meyer, {R. F.} and A.[experts.umich.edu]
  • , treatment, prevention, prognosis, and additional useful information HERE .[dovemed.com]

Etiology

  • Slit-lamp biomicroscopy and in vivo confocal microscopy were used to evaluate the etiology of his complaints. Clinical photographs and confocal micrographs were analyzed.[ncbi.nlm.nih.gov]
  • We recommend submitting the corneal tissue obtained during DSAEK for pathological examination when the etiology of corneal edema is unclear.[jhu.pure.elsevier.com]
  • Conclusion ICE is a rare, progressive, congenital, unilateral disease, of unknown etiology ,occurring in middle aged females.[medresearch.in]

Epidemiology

  • . • INTRODUCTION • HISTORY • EPIDEMIOLOGY • ETIOPATHOGENESIS • CLINICAL FEATURES • D/D • INVESTIGATIONS • MANAGEMENT 3.[slideshare.net]
  • Diagnosis: Iridocorneal Endothelial Syndrome (ICE) - essential iris atrophy EPIDEMIOLOGY incidence: unknown, rare.[webeye.ophth.uiowa.edu]
  • […] endothelium, resulting in its unusual epithelial-like activity. [1] [6] Polymerase Chain Reaction (PCR) testing of corneal endothelial cells from ICE syndrome patients has been found to have high percentages of HSV DNA in comparison to normal controls. [6] Epidemiology[eyewiki.aao.org]
Sex distribution
Age distribution

Pathophysiology

  • Decreased endothelial permeability to solutes has not been documented previously in any clinical corneal disorder and may be of importance in the pathophysiologic changes that accompany endothelial disease.[ncbi.nlm.nih.gov]
  • All the ICE syndromes share a common underlying pathophysiology and can all be considered to be primary proliferative endothelial degenerations.5 The corneal endothelium has a fine beaten-silver appearance.[macfarlaneoptometrist.com.au]
  • Now thought of as a syndrome with a common fundamental pathophysiological basis but a spectrum of clinical manifestations, it is historically subdivided into essential (progressive) iris atrophy, Chandler syndrome, and Cogan-Reese (iris-nevus) syndrome[glaucomatoday.com]
  • The 3 general pathophysiological mechanisms of increased EVP are arteriovenous anomalies, venous obstruction, and idiopathic.[emedicine.medscape.com]
  • Possible pathophysiology triggering the association needs better understanding. Acknowledgements The author is grateful to the patient for his cooperation.[ijo.in]

Prevention

  • Penetrating keratoplasty produced visual improvement in 7 of the 9 cases, relief of pain in 6 of 6 cases, and prevention of further corneal infection in 1 case.[ncbi.nlm.nih.gov]
  • Leaving the tube long so that it extends far away from the anterior chamber angle and the iris can often prevent these issues.[reviewofophthalmology.com]
  • It is especially of value in cases of Chandler’s syndrome, where corneal oedema may prevent examination of the endothelium by specular microscopy.[bjo.bmj.com]

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