Inferior bullous keratopathy caused by iris fibers, resolved with diode laser 532

Abstract

Purpose: To describe a case of inferior bullous keratopathy caused by iris fibers resolved with laser diode 532.Case report: A 74-year-old woman consulted for deterioration of visual acuity in right eye, accompanied by foreign body sensation. A phacoemulsification surgery with IOL implant had been performed in both eyes three months before. Best corrected visual acuity reached 20/40 in right eye. Slit lamp examination revealed bullous keratopathy located in the central inferior quarter of the cornea of her right eye. Gonosioscopy was performed to rule out having nucleus fragments in the inferior angle. With higher magnification, a pair of fine undulating fibers were observed coming from the anterior layers of the iris and making contact with the posterior face of the cornea. Photocoagulation of the iris fibers was performed with laser diode 532 and photodisruption with Nd-YAG laser, applied at the base of the fibers. After nine days, resolution of corneal edema, and disappearance of bullae was observed.  Best corrected visual acuity improved to of 20/25.Conclusions: photocoagulation of iris fibers with laser diode 532 complemented with photodisruption with Nd-YAG laser, in patients with iridoschisis, is an alternative to avoid endothelial decompensation and corneal edema, which may require a corneal transplantation.