{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:41:21Z","timestamp":1762195281036,"version":"build-2065373602"},"reference-count":20,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,8,15]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>A woman in her late 30s presented with 20 days of severe diminution of vision in her right eye, accompanied by discomfort and headache. On presentation, intraocular pressure (IOP) was 50\u202fmm Hg, and after 1 week of resumed therapy, it remained uncontrolled at 30\u202fmm Hg.<\/jats:p>\n                  <jats:p>Gonioscopy revealed broad-based peripheral anterior synechiae and focal goniosynechiae. Slit lamp examination showed fine pigment on the posterior corneal surface without iris atrophy. Specular microscopy demonstrated markedly reduced traceable cell counts due to light scatter from a subclinical endothelial membrane and pigment, yet showed polymegathism and pleomorphism; pachymetry and slit lamp findings excluded corneal oedema. HSV (Herpes Simplex Virus) PCR was not performed due to cost constraints; corneal sensations were intact. A diagnosis of Chandler\u2019s variant ICE (IridoCornealEndothelial) syndrome with refractory glaucoma was made. The patient underwent trabeculectomy with mitomycin C, achieving IOP of 12\u2009mm Hg. Learning points include the recognition of specular microscopy artefacts, reliance on clinical correlation and management challenges in resource-limited settings.<\/jats:p>","DOI":"10.1136\/bcr-2025-266789","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T06:00:26Z","timestamp":1759471226000},"page":"e266789","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Refractory Glaucoma in Chandler\u2019s variant of Iridocorneal Endothelial Syndrome"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4784-1248","authenticated-orcid":false,"given":"Aahan","family":"Shah","sequence":"first","affiliation":[{"name":"Ophthalmology, JIPMER, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Stephen","sequence":"additional","affiliation":[{"name":"Ophthalmology, JIPMER, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archit","family":"Gupta","sequence":"additional","affiliation":[{"name":"Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subashini","family":"Kaliaperumal","sequence":"additional","affiliation":[{"name":"Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"2025110310203199000_18.10.e266789.1","first-page":"23","article-title":"The iridocorneal endothelial syndrome: a clinical and laboratory review","volume":"62","author":"Spaeth","year":"2017","journal-title":"Surv Ophthalmol"},{"key":"2025110310203199000_18.10.e266789.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0171884","article-title":"Glaucoma associated with iridocorneal endothelial syndrome in 203 Indian subjects","volume":"12","author":"Chandran","year":"2017","journal-title":"PLoS ONE"},{"key":"2025110310203199000_18.10.e266789.3","unstructured":"Genetic and Rare Diseases Information Center . Chandler syndrome. NIH; 2025. Available: https:\/\/rarediseases.info.nih.gov\/diseases\/6033\/chandler-syndrome"},{"key":"2025110310203199000_18.10.e266789.4","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/S0161-6420(99)00077-9","article-title":"Outcome of trabeculectomy with mitomycin-C in the iridocorneal endothelial syndrome","volume":"107","author":"Lanzl","year":"2000","journal-title":"Ophthalmology"},{"key":"2025110310203199000_18.10.e266789.5","first-page":"567","article-title":"Challenges in specular microscopy: artifact and fixation","volume":"41","author":"Yang","year":"2022","journal-title":"Cornea"},{"key":"2025110310203199000_18.10.e266789.6","first-page":"1296","article-title":"Primary trabeculectomy with mitomycinC outcomes in ICE syndrome","volume":"29","author":"Mandal","year":"2015","journal-title":"Eye (Lond)"},{"key":"2025110310203199000_18.10.e266789.7","first-page":"281","article-title":"Clinical and specular microscopic manifestations of ICE syndrome","volume":"90","author":"Chang","year":"1980","journal-title":"Am J Ophthalmol"},{"key":"2025110310203199000_18.10.e266789.8","unstructured":"Moran CORE . Iridocorneal endothelial syndrome. Moran CORE; 2025. Available: https:\/\/morancore.utah.edu\/section-10-glaucoma\/iridocorneal-endothelial-ice-syndrome\/"},{"key":"2025110310203199000_18.10.e266789.9","first-page":"120","article-title":"Contemporary management of secondary glaucoma","volume":"29","author":"Borrero","year":"2018","journal-title":"Curr Opin Ophthalmol"},{"key":"2025110310203199000_18.10.e266789.10","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(83)90234-5"},{"key":"2025110310203199000_18.10.e266789.11","doi-asserted-by":"crossref","first-page":"528","DOI":"10.4103\/ijo.IJO_1123_19","article-title":"Bilateral Chandler\u2019s syndrome: Uncommon entity diagnosed by ultrasound biomicroscopy and confocal microscopy","volume":"68","author":"Ichhpujani","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"2025110310203199000_18.10.e266789.12","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.jcrs.2007.12.047","article-title":"Chandler syndrome manifesting as ectropion uvea after LASIK","volume":"34","author":"Mocan","year":"2008","journal-title":"J Cataract Refract Surg"},{"key":"2025110310203199000_18.10.e266789.13","unstructured":"Phillips DL , Toral M , Alward WLM . Chandler syndrome: a subtle presentation. EyeRoundsOrg; 2015. Available: https:\/\/www.researchgate.net\/profile\/Marcus-Toral\/publication\/281584377_Chandler_Syndrome_A_subtle_presentation\/links\/55ee9e4a08ae0af8ee1a1d65\/Chandler-Syndrome-A-subtle-presentation.pdf?utm_source=chatgpt.com"},{"key":"2025110310203199000_18.10.e266789.14","doi-asserted-by":"crossref","first-page":"589","DOI":"10.18203\/2349-3933.ijam20171065","article-title":"Medical and surgical management has a role in control of intraocular pressure in early detected iridocorneal endothelial syndrome: case series","volume":"4","author":"Rath","year":"2017","journal-title":"Int J Adv Med"},{"key":"2025110310203199000_18.10.e266789.15","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5005\/jp-journals-10078-1444","article-title":"Bilateral Chandler Syndrome, Nanophthalmos, and Angle Closure Glaucoma: A Complex Presentation, Challenging Diagnosis, and Pathological Insight-A Case Report","volume":"18","author":"Ismail","year":"2024","journal-title":"J Curr Glaucoma Pract"},{"key":"2025110310203199000_18.10.e266789.16","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s10792-016-0317-1","article-title":"Surgical outcomes of patients with iridocorneal endothelial syndrome: a case series","volume":"37","author":"Imamoglu","year":"2017","journal-title":"Int Ophthalmol"},{"key":"2025110310203199000_18.10.e266789.17","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/ICO.0000000000000122","article-title":"Phenotypic heterogeneity of corneal endothelium in iridocorneal endothelial syndrome by in vivo confocal microscopy","volume":"33","author":"Malhotra","year":"2014","journal-title":"Cornea"},{"key":"2025110310203199000_18.10.e266789.18","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2005.074864"},{"key":"2025110310203199000_18.10.e266789.19","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.78.8.624"},{"key":"2025110310203199000_18.10.e266789.20","doi-asserted-by":"crossref","first-page":"778","DOI":"10.3390\/microorganisms13040778","article-title":"Herpesvirus Infections of the Corneal Endothelium","volume":"13","author":"Wang","year":"2024","journal-title":"Microorganisms"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:20:45Z","timestamp":1762194045000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,2]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1136\/bcr-2025-266789"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266789","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}