Case Report: Iridocorneal Endothelial Syndrome Progression Documented by Anterior Segment Optical Coherence Tomography.

SIGNIFICANCE: Iridocorneal endothelial (ICE) syndrome is characterized by a difficult-to-see membrane of ectopic corneal endothelial cells, called an ICE membrane. This report demonstrates that ICE membranes are detectable by anterior segment optical coherence tomography (AS-OCT) and highlights the benefits of using AS-OCT in ICE syndrome. PURPOSE: A case of ICE syndrome is reported to highlight the utility of AS-OCT in the characterization and diagnosis of the disease. CASE REPORT: A 65-year-old African American man was diagnosed as having the Chandler variant of ICE syndrome of the left eye. He was treated topically for corneal edema. Anterior segment optical coherence tomography and anterior segment photography were used to aid in the diagnosis and document an ICE membrane and multiple peripheral anterior synechiae. Further examinations chronicled the progression of a peripheral anterior synechia. At first, only iridocorneal touch (sparing the trabecular meshwork) was present, but later, full apposition to the trabecular meshwork developed. The patient was diagnosed as having pre-perimetric glaucoma in the left eye and is being treated topically to reduce his intraocular pressure. The right eye remains unremarkable. CONCLUSIONS: Anterior segment optical coherence tomography can support the diagnosis of ICE syndrome by visualizing ICE membranes and differentiating between true peripheral anterior synechiae and iridocorneal touch that does not block the trabecular meshwork. Chronicling ICE membranes longitudinally with AS-OCT will enhance understanding of disease progression. By correlating membranes features (such as location and extent) and patient outcomes, AS-OCT-based ICE membrane classifications can be developed to improve the management and prognosis of ICE syndrome.

Retinal Arterioles in Hypo-, Normo-, and Hypertensive Subjects Measured Using Adaptive Optics.

PURPOSE: Small artery and arteriolar walls thicken due to elevated blood pressure. Vascular wall thickness show a correlation with hypertensive subject history and risk for stroke and cardiovascular events. METHODS: The inner and outer diameter of retinal arterioles from less than 10 to over 150 µm were measured using a multiply scattered light adaptive optics scanning laser ophthalmoscope (AOSLO). These measurements were made on three populations, one with habitual blood pressures less than 100/70 mm Hg, one with normal blood pressures without medication, and one with managed essential hypertension. RESULTS: The wall to lumen ratio was largest for the smallest arterioles for all three populations. Data from the hypotensive group had a linear relationship between outer and inner diameters (r2 = 0.99) suggesting a similar wall structure in individuals prior to elevated blood pressures. Hypertensive subjects fell below the 95% confidence limits for the hypotensive relationship and had larger wall to lumen ratios and the normotensive group results fell between the other two groups. CONCLUSION: High-resolution retinal imaging of subjects with essential hypertension showed a significant decrease in vessel inner diameter for a given outer diameter, and increases in wall to lumen ratio and wall cross-sectional areas over the entire range of vessel diameters and suggests that correcting for vessel size may improve the ability to identify significant vascular changes. TRANSLATIONAL RELEVANCE: High-resolution imaging allows precise measurement of vasculature and by comparing results across risk populations may allow improved identification of individuals undergoing hypertensive arterial wall remodeling.