Chandler's Syndrome as a Variant of Essential Iris Atrophy

Trabeculectomy and peripheral iridectomy specimens from one male and two female patients with Chandler's syndrome (age, 30 to 42 years) showed that all had unilateral corneal endothelial "dystrophy," corneal edema, mild to moderate iris atrophy without holes, peripheral anterior synechiae, and glaucoma. In one, fluorescein angiography of the iris disclosed a sector filling delay of limbal and conjunctival vessels and pupillary and extrapupillary leakage. Histopathologic examination showed a layer of degenerated corneal endothelium and Descemet's membrane extending across the inner uveal trabeculum. Descemet's membrane displayed irregular, nodular, scroll-like excrescences in some cases, and thinner placoid configurations with abnormal widely spaced collagen (100 nm) in others. Corneal endothelial cells exhibited increased microvilli, widened cellular interdigitations, and occasional shrunken cells with enlarged or disrupted cytoplasmic blebs. Peripheral iris specimens displayed mild to moderate stromal atrophy without vascular occlusions. Pigment epithelium was normal.