Iridoschisis and the corneal endothelium

Iridoschisis has been known as a rare entity for the past 60 years, since its first description by Schmitt. It has been reported most frequently in eyes with a history of trauma or one of the glaucomas. While freely floating fibers of disrupted iris mesenchyma may be seen to brush against the corneal endothelium in many patients, there has never been a report of corneal compromise secondary to iridoschisis. A patient with bilateral glaucoma is described. Iridoschisis was present in one eye, and specular microscopy revealed a marked decrease in cell density (600 cells per square millimeter) directly over the split iris fibers. A high degree of polymegethism was also present over the involved sector of iris. Cell counts and morphological findings elsewhere in the cornea were normal for the patient's age. Iridoschisis may be a hitherto unrecognized cause of endothelial decompensation. In selected cases, prophylactic surgical iridectomy should be considered in order to remove the disrupted iris fibers that may play a role in corneal changes.