Download PDF

Make your diagnosis in the comments, and look for the answer in next month’s Blink.

Last Month’s Blink

Scroll of Iris Pigment Epithelium

Written by Michael E. Snyder, MD, and Megan M. Tuohy, MD. Both are at Cincinnati Eye Institute and University of Cincinnati. Photo by Dr. Snyder.

A 53-year-old man noticed a shadow moving in the vision of his right eye. An avid astronomy photographer and pilot of autogyro aircraft, he had undergone cataract surgery a few years previously. The shadow was worse when he was participating in both of these high-acuity, uniform background tasks.

His examination was remarkable for an elongated, darkly pigmented, mobile excrescence bisecting the pupil (Fig. 1) and dangling from the poste­rior midperiphery of the iris (Fig. 2). There was a similarly sized transillumination defect extending from the apparent location of attachment circum­ferentially in the clockwise direction, roughly the same distance as the length of the lesion (Fig. 3). The anterior segment was otherwise pristinely pseudophakic.

We concluded that this lesion was a scroll of iris pigment epithelium. The scroll was removed in the operating room uneventfully, and the symp­toms resolved. Loose scrolls, flaps, or sheets of iris pigment epithelium occur rarely.¹ This entity is unlike iridoschisis syndrome, in which the stromal cords spontaneously and progressively fray.^2,3 The delamination of the pigment epithelial layer from the overlying normal, untraumatized stroma typically occurs spontaneously and atraumatically during anterior segment surgery. The loose tissue can be modest, as in this case, or can involve larger amounts of iris. We once saw the entire pigment epithelium that had separated in one sheet!

___________________________

1 Kreuger J et. al. Klin Monbl Augenheilkd. 2018. doi: 10.1055/s-0043-124653.

2 Pieklarz B et. al. J Clin Med. 2020;9(10):3324.

3 Snyder ME et al. Can J Ophthalmol. 2019;54(5):e221-e225.

Read your colleagues’ discussion.