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.