RESUMO
BACKGROUND: Iridoschisis is a rare ophthalmological disorder that presents with the separation of the anterior fibers of the iris from the posterior ones at the level of the stromal layer. Fibers resulting from the disintegration of the anterior iris layers can be encountered in the anterior chamber of the affected eyes. This condition mostly affects females and has been associated with both open-angle and angle-closure glaucoma. The pathogenesis has not been clarified yet, and the treatment is still a matter of discussion. OBJECTIVE: We want to contribute to the understanding of the pathogenesis and natural course of the disease as well as to document with multimodal imaging a new case of this very rare disease. CASE REPORT: We present a case of a 71-year-old woman affected by iridoschisis in both eyes followed by 3 consecutive visits every 4 months. We performed an extensive ophthalmologic examination, including gonioscopy, endothelial cell microscopy, and optical coherence tomography of the anterior segment. CONCLUSION: In our report, we documented a possible natural course of iridoschisis, characterized by an acute worsening followed by a phase of stability, and formulated some hypotheses on the pathogenesis of this rare disease.
RESUMO
PURPOSE: To assess the structure and function of the retinal posterior pole in patients with early Parkinson's disease (PD) and to identify possible biomarkers correlated with clinical features. PATIENTS AND METHODS: A cross-sectional case-control study of 21 patients with PD and 22 age-matched healthy controls (HC) was conducted. All subjects underwent full ophthalmological examinations, fundus perimetry (FP) and spectral domain-OCT (SD-OCT) of the entire retinal posterior pole and peripapillary retinal nerve fiber layer (pRNFL). RESULTS: We analyzed 41 eyes from 21 patients (14 males and 7 females) with early PD (Hoehn and Yahr scale (H&Y) equal to or less than stage 2) and 41 eyes from 22 HC (12 males and 10 females). We found no significant difference in the pRNFL thickness between patients with PD and HC. The statistical analysis of the SD-OCT posterior pole area, consisting of 64 values for each retinal layer, revealed a decrease in the outer nuclear layer (ONL) thickness in patients with PD (p < 0.0001). On the contrary, a significant increase in the thickness of the outer plexiform layer (OPL) (p < 0.0001) and of the retinal pigmented epithelium (RPE) (p= 0.002) compared to healthy controls was detected. Other retinal layers showed no significant statistical differences. The differential light sensitivity (DLS) values measured by FP were significantly lower in patients than the healthy controls (15 [13-16.2] vs 17.95 [16.08-18.96] p<0.0001). CONCLUSION: Our results showed that DLS and retinal structure differed in the posterior pole between patients with early PD and controls. Thickening of the OPL may represent accumulation of α-synuclein in the OPL of patients with PD.