4 Cases of Surgical Iris Repair

From CataractCoach.com: This young man sustained a terrible trauma which resulted in severe ocular trauma. A shard of glass penetrated his inferior limbus and damaged his iris and punctured his crystalline lens. He had an immediate repair of the ruptured globe with removal of the glass shard and a lensectomy. He then lived in this monocular status for a few years due to lack of access to healthcare. This resulted in sensory exotropia which compounded his problems. Can we do surgery to help him? Can we address multiple issues at the same sitting?

During extensive pre-op testing, we found that a contact lens in a power of about +12 resulted in a visual acuity of 20/40 with the limitation being the mild corneal irregularity which occurred with the initial trauma. However, with contact lens use, the patient had intractable diplopia which did not resolve. It was clear that a strabismus surgery would be necessary for this patient. The secondary IOL would help restore the vision without use of a contact lens, which the patient found difficult to tolerate for more than a few hours at a time. Finally, repairing the iris damage would result in a more physiologic pupil but also would dramatically improve the cosmetic appearance of the eye, which is particularly important to a young patient.

This patient underwent a surgical repair with a scleral-sutured IOL, pupilloplasty, and strabismus surgery to align the eye. After a few weeks of recovery, the patient looked great and more importantly, saw very well.

Sometimes iatrogenic trauma can be the cause of the iris damage. Particularly now, when so many of our patients present with IFIS (intra-operative floppy iris syndrome) due to Flomax (tamsulosin) use. The following patient had cataract surgery with severe floppy iris which resulted in sub-incisional loss of the iris and mis-placement of the IOL with the nasal haptic in the sulcus and the temporal haptic in the capsular bag. This resulted in de-centration of the IOL which resulted in poor vision along with dysphotopsias due to the corectopia.

Other cases from blunt trauma are more difficult to repair. This young patient had a pellet gun injury which resulted in severe iris damage as well as rupture of the anterior lens capsule. A white cataract soon developed along with severe ocular inflammation.

Watch the video below for instructions on how I performed the IOL exchange and then repaired the iris defect using 10-0 polypropylene suture to re-approximate the tissue.