case_images: PMC10616668_01
case_images: Slit lamp photography. a OS with a nuclear cataract and progressive iris atrophy iridocorneal endothelial (ICE) syndrome. Grade 1 corneal edema and three atrophic peripheric iris holes are seen. b Grade 3 corneal edema 6 months post-cataract surgery and artificial iris placement. c Day one post-Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery, showing a well-positioned graft and the residual air bubble. d Six months post-DSAEK with a clear cornea and the implanted iris prosthesis and intraocular lens (IOL) in their correct placement.
case_images: cop-2023-0014-0001-534277_F01.jpg
case_images: PMC10616668_01_cop-2023-0014-0001-534277_F01.jpg
case_images: F1
case_images: Slit lamp examination of the left eye revealed a hazy cornea with a "beaten bronze" appearance when viewed in specularly reflected light, pseudopolycoria, with 3 peripheric holes at 2, 7, and 9 h (Fig. 1a); and a nuclear sclerotic cataract. At the 6-month follow-up appointment, a centered artificial iris and a correctly placed pseudophakic IOL were observed, together with grade 3 corneal edema; no visual acuity improvement was appreciated (Fig. 1b). At postoperative day 1, the lenticule was attached, the anterior chamber was formed and IOP was normal (Fig. 1c). The implanted iris prosthesis and IOL were correctly positioned and centered, all iris holes were covered, and the pupil presented only with slight corectopia (Fig. 1d, 3).
case_images: Specular microscopy. a Corneal endothelium showing typical findings of ICE syndrome. b Normal endothelium morphology, with 1,640 cell/mm2 count, 6 months after DSAEK.
case_images: cop-2023-0014-0001-534277_F02.jpg
case_images: PMC10616668_01_cop-2023-0014-0001-534277_F02.jpg
case_images: F2
case_images: Automatic endothelial specular microscopy OR revealed a normal endothelium with 2,700 cell/mm2, while the OS revealed rounded, dark ICE cells with light borders (dark/light reversal), pathognomonic of ICE syndrome (Fig. 2a). Endothelial microscopy revealed a DSAEK with normal endothelium morphology and a 1,640 cell/mm2 central count (Fig. 2b).
case_images: OS SPECTRALIS SD-OCT retinal nerve fiber layer thickness (RNFLT) and minimum rim width (MRW) analysis showing no signs of glaucomatous damage, with RNFLT and MRW within the normal range of the normative values.
case_images: cop-2023-0014-0001-534277_F03.jpg
case_images: PMC10616668_01_cop-2023-0014-0001-534277_F03.jpg
case_images: F3
case_images: OCT measured retinal nerve fiber layer thickness revealed a global thickness of 115 mum (Fig. 3). The implanted iris prosthesis and IOL were correctly positioned and centered, all iris holes were covered, and the pupil presented only with slight corectopia (Fig. 1d, 3).
case_images: Labeled anterior segment OCT image of OS post phacoemulsification with IOL placement, endocapsular artificial iris placement, and DSAEK surgery. DSAEK, Descemet's stripping with endothelial keratoplasty.
case_images: cop-2023-0014-0001-534277_F04.jpg
case_images: PMC10616668_01_cop-2023-0014-0001-534277_F04.jpg
case_images: F4
case_images: In Figure 4, the anterior segment OCT examination (Anterion, Heidelberg, Germany) illustrates all structures mentioned in the case properly positioned and centered on the visual axis.