Iris nevus (Cogan-Reese) syndrome. A cause of unilateral glaucoma.

Fourteen patients (ten women, four men) with iris nevus (Cogan-Reese) syndrome, all having unilateral glaucoma, were studied clinically. Many had corneal edema, and all had changes in the iris consisting of one or more of the following: iris whorls or nodules or both, atrophy of iris stroma, heterochromia (the darker iris usually involved), or ectropion uveae. All had peripheral anterior synechias. Material for histological study was available from ten patients and showed a nonmalignant diffuse nevus of the anterior surface of the iris. An overgrowth of endothelium and Descemet membrane extending onto the iris surface may be a characteristic part of the process. Patients tended to be women in middle age. Conservative treatment avoiding enucleation is advised. Whenever a patient with suspected iris nevus syndrome or essential iris atrophy is subjected to glaucoma surgery, a biopsy specimen of the iris should be obtained for histological study.

Endothelialization of filtering bleb in iris nevus syndrome.

Late failure of a filtering cicatrix occurred in a patient who had had surgery to control the glaucoma associated with the iris nevus syndrome (Cogan-Reese). The internal surface of the filtration site, as well as the anterior chamber angle, proved to be lined by corneal endothelium that had laid down a new, thick basement membrane (Descemet). The new endothelium-basement membrane probably obstructed the flow of aqueous into the bleb. Endothelialization of a filtering bleb is not unique to the iris nevus syndrome; other causes are discussed.

Essential iris atrophy. Report of a case.

The clinicopathologic findings in an eye from a 40-year-old man with essential iris atrophy are reported. Noteworthy is the proliferation of corneal endothelium and a laying down of a new Descemet (cuticular) membrane over the trabecular meshwork and in areas of anterior peripheral synechiae formation over the pseudoangle. The histologic characteristics favor a vascular cause for the condition, but the evidence is circumstantial.

Management of persistent filtering cicatrix following cataract extraction.

We used a safe and simple surgical technique in the management of persistent filtering cicatrices after cataract extraction. The edematous, friable filtering cicatrix was excised entirely and a healthy fornix-based conjunctival flap was sutured over the fistula. Invariably, the fistula was very small, usually only large enough to admit a 27-gauge needle. Of the 27 eyes treated with this technique, there were two failures, but no other complications.

Rubeosis in Fuchs heterochromic iridocyclitis.

A patient had Fuchs heterochromic iridocyclitis of approximately 17 years' duration. Histologically, keratic precipitates, iris atrophy, rubeosis iridis, discontinuous rubeosis of the anterior chamber angle, a chronic nongranulomatous iridocyclitis, and trabeculitis were noted. The cause of the glaucoma probably is a combination of rubeosis of the anterior chamber angle and trabeculitis.

Periorbital scleroderma associated with heterochromia iridis.

Two patients had biopsy-proven linear scleroderma, associated with a pigmentary abnormality of the anterior segment of the eye. One patient had heterochromia iridis, atrophy of the upper eyelid, a typical coup de sabre lesion, and a markedly asymmetric pigmentary glaucoma. The second patient had bilateral scalp involvement, paresis of the extraocular muscles, blepharoptosis, and heterochromia iridis.

Superficial reticular degeneration of Koby.

A 36-year-old white man with congenital ichthyosis and a history of a posterior uveitis beginning at age 8 presented with an unusual corneal opacity. At age 26 bilateral central corneal opacities were noted consisting of fine interlacing white lines forming a reticulum at the level of Bowman's membrane. A faint brown background tint of the basal epithelium was also present. Over the next 10 years the opacity progressed only slightly, with some mild superficial scarring of the underlying corneal stroma. The visual acuity remained good. This corneal pattern appeared virtually identical to the superficial reticular degeneration of Koby. As described by Koby in 1927, this rare corneal degeneration is characterised as a painless, slow, progressive development of a central fine, white reticulum at the level of Bowman's membrane. This rare corneal degeneration probably represents an atypical form of band keratopathy.

Pigment dispersion syndrome: a clinical study.

This study involved a group of 407 patients (799 eyes) with pigment dispersion syndrome gathered from a glaucoma population of 9200 patients. The sex distribution was equal. The majority (65%) of patients were myopic. The incidence of retinal detachment was 6.4%. No patients were black, but 5 were mulatto. Approximately one-quarter of the patients wih pigment dispersion syndrome (31% of the men, 19% of the women) had glaucoma. The average age of onset of glaucoma was 15 years less than in control patients with chronic simple glaucoma. When both eyes were affected by glaucoma, the glaucoma was consistently more severe in the eye with the more heavily pigmented angle. The degree of iris transillumination was found to be of no importance in predicting the presence of glaucoma or the severity of trabecular pigmentation. The pressure in 66% of the eyes with pigmentary glaucoma was controlled medically. A higher percentage of patients with pigmentary glaucoma required surgery than patients in the control group with chronic simple glaucoma. Men with pigmentary glaucoma required surgery at a much earlier age than women with pigmentary glaucoma.

Keratoconus associated with corneal endothelial dystrophy.

Keratoconus is found in conjunction with many ocular and nonocular disorders. We describe five patients with concurrent keratoconus and corneal endothelial dystrophy.

Iridectomy with scleral cautery.

I have described modifications that have evolved over the years in doing iridectomy with cautery and have reviewed some of my experiences with the method. All filtering operations leave a great deal to be desired. Each technique has certain advantages and disadvantages. A great advantage of the cautery procedure is its safety and simplicity. It is as effective in lowering pressure as most other procedures. Even if the operation fails to control pressure, little harm is done to the eye, and it can be repeated. One of the great advances in management of open-angle glaucoma in recent years has been the adoption of stringent indications for surgery. Surgery should not be advised until a thorough trial of maximal medical therapy has been made. In many instances, however, the pendulum has been allowed to swing too far. When medical treatment has failed, and the patient is faced with progressive loss of vision if control of pressure is not achieved, the ophthalmic surgeon should resist the temptation to procrastinate. Surgery should be done promptly and deterioration should not be allowed to occur. Should a cataract occur, it can be removed. Endophthalmitis can be prevented or cured by antibiotic therapy. Although filtering operations leave a great deal to be desired, when effective, they will preserve a functioning optic nerve.