Phacoemulsification In A Rare Bilateral Iridocorneal Endothelial Syndrome

To describe the surgical challenges and outcomes of cataract extraction in a patient with advanced Iridocorneal Endothelial (ICE) syndrome, emphasizing intraoperative modifications required in the presence of distorted anterior segment anatomy and compromised corneal endothelium.

Tertiary government hospital

A 65-year-old female presented with ocular pain, redness, and progressive visual loss. Visual acuity was no light perception in the right eye and hand movements in the left eye. Intraocular pressure measured 50 mmHg in the right eye and 20 mmHg in the left eye. Slit-lamp examination revealed corneal edema, iris atrophy, 360° high peripheral anterior synechiae, and total white cataracts in both eyes. Specular microscopy demonstrated endothelial pleomorphism and polymegathism, while anterior segment optical coherence tomography confirmed extensive peripheral iris adhesions. A diagnosis of bilateral ICE syndrome with advanced cataract was made. Phacoemulsification was performed on the left eye using intracameral epinephrine, viscoelastic-assisted synechialysis, and mechanical pupil stretching due to poor pupillary dilation. The procedure was completed successfully with implantation of a hydrophobic monofocal intraocular lens.

Cataract surgery in patients with ICE syndrome requires meticulous preoperative assessment and individualized intraoperative strategies to address poor pupillary dilation, corneal edema, and extensive synechiae. While surgery may be technically successful, postoperative visual outcomes can be limited by underlying endothelial dysfunction. Long-term surveillance for glaucoma progression and corneal decompensation is essential for optimal patient management.