Occult iris holes in Rieger anomaly

Abstract

A 64-year-old man presented at the Aravind Eye Hospital, Puducherry, India, with decreased visual acuity of 1 year’s duration. Slit lamp biomicroscopy revealed an altered iris pattern, with immature cataract in each eye. Gonioscopy revealed peripheral anterior synechia leading to angle closure, with raised intraocular pressure in each eye. Prophylactic laser peripheral iridotomy was performed in each eye. On follow-up, 2 weeks after initial presentation, retroillumination after dilation showed bilateral iris holes suggestive of Rieger’s anomaly. On dilated fundus evaluation, cup-to-disc ratio in the right eye was 0.8, with superior and inferior notching; in the left eye, 0.6.