EDITED FILM


ABSTRACT

Iris defects combined with crystalline lens abnormalities are among the major complications of globe blunt trauma. Post-traumatic partial or total iris defects can cause glare, reduced contrast sensitivity, decreased vision, photophobia as well as cosmetic problems. When there is extensive iris damage repair may be impossible and artificial iris implants can be used to restore iris diaphragm, reducing aniridia associate d symptoms. Combined post-traumatic aniridia and aphakia present a surgical challenge and demand a complex reconstructive surgery.

We present a case of traumatic aphakia-aniridia treated with transscleral fixation of an artificial iris-intraocular lens (IOL) combined prothesis, with good functional and aesthetic result. A 53 years old male with previous history of blunt trauma to his right eye causing iris expulsion, crystalline lens posterior luxation and retinal detachment. He had been submitted to pars plana vitrectomy and lensectomy and silicone oil-tamponade. The patient complaint of low vision and photophobia. Ophthalmologic examination showed a best corrected visual acuity (with +12.0 diopters correction) of 6/10, clear cornea, deep anterior chamber, aniridia, aphakia and normal fundus under silicone oil tamponade. We decided to perform silicone oil extraction combined with implantation of an artificial iris prothesis and IOL. Surgery was performed under general anesthesia. First we proceeded with silicone oil extraction, followed by careful inspection of the retina. Following, the artificial iris prothesis was trephined according to preoperative white-to-white measurement, a small peripheral iridectomy was performed and a foldable 3-piece IOL was fixated to the final remodelled iris prothesis. Because there was no capsular support, the artificial iris-IOL complex was secured with transscleral fixation using 10-0 polypropylene sutures at 3 equally distant positions. Post-operative period was uneventful. At six-month follow-up visual acuity was 8/10, with clear cornea and intraocular pressure was 16 mmHg. Photophobia was resolved and the patient was pleased with both the functional and cosmetic outcome. Artificial iris prothesis present a good solution in post-traumatic eyes with aniridia, improving symptoms like photophobia and glare, as well as cosmetic aspects. Combining haptic fixation of a foldable IOL on a foldable iris prosthesis allows combined correction of aphakia-aniridia in one procedure, through a relatively small corneal incision, with excellet aesthetic and functional outcomes.


CONTACT DETAILS

David MARTINS & Ines MATIAS, Pedro GOMES, Sivia DINIZ, Pedro NEVES, Mario ORNELAS
Ophthalmology Department, Setubal Hospital Center
Setubal, Portugal
Email : drdavidmartins@hotmail.com
Cell Phone: +351964029156
Work Phone: +351964029156