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JAMA Ophthalmology Clinical Challenge
August 2016

Elevated Intraocular Pressure and Endothelial Cell Loss Following Iris Color Change

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, Illinois
JAMA Ophthalmol. 2016;134(8):939-940. doi:10.1001/jamaophthalmol.2015.6145

A man in his 30s presented with complaints of bilateral blurry vision, eye redness, and headaches. His ocular history was significant for a motor vehicle crash resulting in likely left optic neuropathy (18 years ago), a procedure performed to change the color of his eyes from brown to blue (4 years ago), and bilateral laser in situ karatomileusis surgery (2 years ago). He was being treated by outside ophthalmologists with loteprednol, nepafenac, timolol, and artificial tears. He did not wear contact lenses. His best-corrected visual acuity was 20/20 OD and 20/30 OS. Anterior slitlamp examination of both eyes revealed the finding shown in Figure 1. His anterior segment was deep and quiet, and his dilated fundus examination was unremarkable. His intraocular pressure (IOP) was reproducibly higher in the right eye on 3 separate visits, averaging 20 mm Hg OD and 13 mm Hg OS. His central corneal thickness was 496 μm OD and 480 μm OS. His endothelial cell count was 1681 cells/mm2 OD and 2045 cells/mm2 OS.