ICE versus PPD

✍ abnormal corneal endothelium migrates across the angle, the trabecular meshwork, and the anterior iris, so causing significant anterior segment distortion.

✍rare

✍ occurs in 20–40 yrs old female

✍ a 50% risk of glaucoma.

✍ triggered by HSV.

✍ three overlapping syndromes

☝Chandler syndrome (predominantly corneal)

☝ essential iris atrophy (predominantly iris changes)

☝iris naveus Cogan–reese syndrome (appearance of a diffuse naevus or pigmented nodules, which probably represent protrusions of iris stroma).

✍ Clinical criteria

☝ Unilateral painfully blurred vision.

☝ Unilateral fine central corneal guttata (beaten metal)

☝ corneal oedema.

☝ with or without high IOP

☝ iris atrophy may cause pseudopolycoria
(accessory pupil).

☝ corectopia (displaced pupil)

☝ Gonioscopy

• broad-based PAS that may insert anterior to Schwalbe’s line.

✍ Investigation

☝specular microscopy to demonstrate endothelial changes.

✍ Treatment

☝ Medical

• β-blocker

• α2-agonist

• carbonic anhydrase inhibitor( CAIs)

• prostaglandin agonist(PGs)

☝ surgery

• trabeculectomy

• augmented Trab ( 5FU or MMC)

• tube procedures

• cyclodestruction

✅ ICE versus PPD Posterior polymorphous dystrophy (PPD)

✍ bilateral

✍ abnormal corneal endothelium may form extensive iridocorneal adhesions, with angle closure.

✍ Clinically similar to ICE syndrome

☝ endothelial vesicle-like lesions

☝ band lesions

☝ diffuse deep stromal opacities.

✍ AD inherited

✍ usually detectable in childhood (although may only be symptomatic later).

✍ PPD carries a 15% risk of glaucoma.

✍ treat glaucoma ( if developed) as for ICE.