3040: subluxed cataract with mydriasis – iris prosthesis or not?
Reconstructing an eye with a subluxed cataract and severe traumatic mydriasis requires thoughtful intraoperative choices to ensure both long-term structural stability and an optimal cosmetic and optical result. While using Gore-Tex suture to secure a capsular tension segment or Cionni ring to the sclera provides fantastic centration, burying the suture knot within scleral grooves would be better to prevent eventual erosion through the conjunctiva over time. Furthermore, for the iris defect, residual tissue trapped in the angle can often be mobilized and successfully repaired using native pupilloplasty techniques, such as a cerclage purse-string or a 4-throw pupilloplasty. If an artificial iris prosthesis is ultimately deemed necessary, placing it directly inside the capsular bag, rather than in the ciliary sulcus, provides superior stability, minimizes pigment dispersion, and reduces the risk of chronic uveal friction. Watch the video to analyze this complex anterior segment reconstruction and weigh the nuances of suture burial and iris repair strategies. What is your go-to repair method for managing traumatic mydriasis in the setting of severe zonular loss? Please comment your thoughts below.
