Case Report: Combined cataract surgery and goniosynechialysis in elderly patients with iridoschisis-a report of two cases.

Iridoschisis, a rare condition involving separation between the anterior iris stroma and deeper layers, primarily occurs in patients between 60 and 70 years of age. The disorder often produces a distinctive "shredded wheat" appearance from iris fibers floating in the anterior chamber, and it commonly coexists with angle-closure glaucoma and cataracts. We present two cases where combined surgical management proved effective. The first case was an 81-year-old woman with bilateral iridoschisis complicated by cataract. Following laser peripheral iridotomy (LPI), gonioscopic examination indicated continued angle closure. Combined phacoemulsification and goniosynechialysis surgery achieved normalized IOP and visual improvement through 18-month follow-up. The second patient was an 82-year-old man with bilateral iridoschisis and narrow angles. The first eye underwent standard cataract surgery. When operating on the second eye, intraoperative gonioscopy identified peripheral anterior synechiae, leading us to add goniosynechialysis. Postoperatively, both eyes showed excellent visual outcomes and stable IOP. For iridoschisis patients, the dual procedure of phacoemulsification and goniosynechialysis addresses two problems simultaneously: the cataract and the anatomical cause of angle closure. The combination thus offers a practical solution for complex iridoschisis cases.