Management of Refractory Glaucoma in Chandler's variant of Iridocorneal Endothelial Syndrome.

A woman in her late 30s presented with 20 days of severe diminution of vision in her right eye, accompanied by discomfort and headache. On presentation, intraocular pressure (IOP) was 50 mm Hg, and after 1 week of resumed therapy, it remained uncontrolled at 30 mm Hg.Gonioscopy revealed broad-based peripheral anterior synechiae and focal goniosynechiae. Slit lamp examination showed fine pigment on the posterior corneal surface without iris atrophy. Specular microscopy demonstrated markedly reduced traceable cell counts due to light scatter from a subclinical endothelial membrane and pigment, yet showed polymegathism and pleomorphism; pachymetry and slit lamp findings excluded corneal oedema. HSV (Herpes Simplex Virus) PCR was not performed due to cost constraints; corneal sensations were intact. A diagnosis of Chandler's variant ICE (IridoCornealEndothelial) syndrome with refractory glaucoma was made. The patient underwent trabeculectomy with mitomycin C, achieving IOP of 12 mm Hg. Learning points include the recognition of specular microscopy artefacts, reliance on clinical correlation and management challenges in resource-limited settings.