Secondary angle-closure glaucoma is a consequence of high PAS, but can at times occur without overt synechiae because the advancing corneal endothelium can functionally close the angle without contraction. Contraction of this tissue within the angle and on the iris results in the high peripheral anterior synechiae (PAS) and iris changes characteristic of ICE syndrome. The altered endothelium migrates posteriorly, moving beyond Schwalbe's line, onto the trabecular meshwork, and at times, onto peripheral iris. Transmission and Scanning Electron Microscopic examination of these cells has demonstrated a population of well-differentiated cells with epithelial features such as desmosomes, tonofilaments, and microvilli. On a pathological level, it is felt that the normal endothelial cells have been replaced with a more epithelial-like cell with migratory characteristics. However, each can result in substantial visual impairment from glaucomatous optic neuropathy and / or corneal edema, making management a challenge.Ĭlinically, the corneal endothelium has been described to have a "hammered silver" or "beaten bronze" appearance in ICE syndrome patients, similar to corneal guttae seen in Fuchs Corneal Endothelial Dystrophy. ICE syndrome is a group of disorders with three clinical variants:Ĭlinical distinction between each subtype can be made based on unique characteristics.
Iridocorneal Endothelial Syndrome (ICE) syndrome is a unique ophthalmic disorder that involves an irregular corneal endothelium that can lead to varying degrees of corneal edema, iris atrophy, and secondary angle-closure glaucoma.
7.1 Iridocorneal endothelial syndrome (ICE).5.2 Essential / Progressive Iris Atrophy:.
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