The reported occurrence of simultaneous iridoschisis and lens subluxation by Adler and Weinberg1 following our report2 furthers our belief that an association between the 2 exists and that the lens may be the culprit in precipitating the schisis of the iris.
The 2 most common associations with iridoschisis—senility and angle-closure glaucoma—have an associated increase in lens size and thickness (age related). Senile degeneration or focal necrosis of the iris, considered to cause iridoschisis in the 2 conditions, may have an additional mechanical precipitating factor from the increased lens size pushing on the iris.
Our patient with unilateral iridoschisis and ipsilateral lens subluxation1 was seen multiple times before and after cataract extraction. The iridoschisis has remained stable over the 10-year follow-up (Figure 1). It was the position of the lens, with its edge pushing the iris, that was an important precipitating factor. The second eye, which did not have lens subluxation, has remained normal. The patient's sister, who has a mildly subluxated lens, did not have a visibly pushed iris and did not develop schisis of the iris. Ultrasound biomicroscopy may be important to studying this connection.
That the case by Adler and Weinberg1 had a right eye temporal lens subluxation with a temporal iridoschisis also favors our observation about the mechanical theory of iridoschisis. The subluxated and thickened central lens would cause the lens–iris contact. Ultrasound biomicroscopy would be helpful. Did they do it in their case? Perhaps this would shed light on the etiology and pathogenesis of this condition.
Shishir Agarwal MS, DNB, FRCS, MRCO, FRF
Jaya Agarwal MS, DNB, MNAMS, FRCS
Trilok P. Agarwal MS
Meerut, Up, India
1. Adler RA, Weinberg RS. Iridoschisis and bilateral lens subluxation associated with periocular eczema. J Cataract Refract Surg 2004; 30:234-236
2. Agarwal S, Agarwal J, Agarwal TP. Iridoschisis associated with lens subluxation. J Cataract Refract Surg 2001; 27:2044-2046