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.
Thank you for the nice surgery. What was the reason of 3 piece IOL in the eye if the posterior capsule was intact?
Either option is ok. Three piece IOLs offer more options for placement
Hi, I’ve had iritis for years , i’am 40 years old had iritis since my early 20s , I’ve since had cataract surgery in both eyes, the first very successful ,there was a slight loss of iris in the last one because the lens was stuck to the iris, I now have one pupil slightly larger than the other which causes me glare. The iris isn’t completely covering the IOL IN THE 3-6 o’clock position .My question is can a suture be done in a uvietic eye while the eye is quiet? I’ve discussed this with my surgeon (a great man) but he hasn’t had a lot of experience in doing this procedure and is slightly hesitant about doing it in an uvietic eye. Can it be done ? Thanks.