Iridoschisis in patients with atopic dermatitis Leads to Intractable Bullous Keratopathy

Background To report iridoschisis in patients with atopic dermatitis and the outcome of repeat corneal transplantations for intractable bullous keratopathy. Case presentation: Three patients with atopic dermatitis, iridoschisis and bullous keratopathy, underwent numerous corneal transplantation procedures including penetrating keratoplasty (PKP), and endothelial keratoplasty (EK), which failed within a short period due to rapid corneal endothelial cell (CEnC) loss without graft rejection. Aqueous humor total protein levels were overwhelmingly higher in all patients. Case1 : A 26-year-old man with atopic dermatitis had iridoschisis and bullous keratopathy in the left eye. During the 10-year follow-up, he underwent six corneal transplantations (three EK, followed by three PKP). However, all grafts failed because of rapid CEnC loss without graft rejection. Case 2 : A 53-year-old man with severe atopic dermatitis had iridoschisis and bullous keratopathy in the right eye. He underwent three corneal transplantations (one EK, followed by two PK) over five years. All grafts failed within short periods due to rapid CEnC loss and endothelial decompensation without graft rejection. Case 3 : A 54-year-old man with severe atopic dermatitis had iridoschisis and bullous keratopathy in the right eye. He underwent two EK within short periods due to rapid CEnC loss. Conclusions We hereby report the association of iridoschisis with bullous keratopathy in atopic dermatitis for the first time in the literature. Clinicians should be aware that the prognosis of corneal transplants in such patients appears to be poor necessitating repeat procedures.