Traumatic Partial Aniridia and Cataract after Iris-Fixated Foldable Phakic Intraocular Lens Implantation
A 27-year-old woman presented with a sudden loss of vision and ocular pain in her left eye after blunt trauma with a hand during a quarrel. The patient had a history of bilateral implantation of an Artiflex pIOL 1 month previously to correct −6.5 diopters (D) of myopia. On initial examination of the left eye, visual acuity was hand motion and the eye had a 6-mm corneoscleral laceration extending from the previous superior clear corneal incision. The iris was dialyzed from 7 to 1 o'clock, and half had prolapsed along with the medial haptic side grasping the iris through the wound; the haptic-optic junction was stuck in the wound (fig. ). The optic and another haptic enclavated on the iris stroma of the pIOL were left in the anterior chamber, and partial hyphema was also present. The absence of retinal detachment and vitreous hemorrhage was confirmed by B-scan ultrasonography.\nAfter removing the firmly enclavated pIOL, the prolapsed iris was repositioned with partial resection of the severely damaged iris. The corneoscleral laceration was repaired with 10-0 nylon with interrupted suture (fig. ). Hyphema and inflammation subsequently subsided, and then a traumatic cataract and a peripapillary subretinal hemorrhage 1 disc diameter in size were found (fig. ).\nThree weeks after surgery, the corneoscleral sutures were removed. The best-corrected visual acuity was 20/40 with −3.75 −4.0 × 130, and the intraocular pressure was normal. Corneal topography showed 4.0 D astigmatism at 40 degrees, and the corneal endothelial cell count was 1,967 cells/mm2. The peripapillary subretinal hemorrhage resolved spontaneously (fig. ).\nSix weeks after primary repair, the traumatic cataract had become denser, and partial aniridia with iridodialysis remained (fig. ). Partial zonular dialysis from 8 to 10 o'clock was noticed. No further change in corneal astigmatism was confirmed by 3 consecutive topographies conducted at 1-month intervals.\nFive months after presentation, the traumatic cataract was removed, and a toric intraocular lens (Acrysof Toric IOL, model SN60T5; Alcon Laboratories, Inc., Fort Worth, Tex., USA; models T6–T9 were not available in Korea) was implanted to correct the large amount of astigmatism. A clear corneal incision was made on the steepest axis of the cornea, and a capsular tension ring was used for partial zonular dialysis. The iridodialysis was repaired with mattress sutures with 10-0 polypropylene (fig. ).\nSix months after the second surgery, the uncorrected visual acuity of the left eye was 20/32 and the best-corrected visual acuity was 20/20 with plano −1.0 × 140. Corneal endothelial cells had decreased to 1,634 cells/mm2 but remained stable by serial examination, and the intraocular pressure was normal. Although partial aniridia remained, the patient experienced no discomfort during daily activities (fig. ).