Expulsive total iridodialysis through microincision phacoemulsification wound

Ruiz‐Medrano, Jorge; Ávalos-Franco, N.; Gutierrez-Bonet, R.; Cifuentes-Canorea, P.; Gegúndez-Fernández, J.A.; Díaz-Valle, D.

doi:10.1016/j.jfo.2015.12.011

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…Several cases of traumatic aniridia with simultaneous intraocular lens and capsular bag preservation in eyes with a history of cataract extraction have been reported [ 7 – 10 ]. The researchers, therefore, proposed that the impact caused the original corneal tunnel to open, and the iris tissue was completely dislodged and expelled through a clear corneal surgical incision.…”

Section: Discussionmentioning

confidence: 99%

Traumatic dislocation of the iris into the vitreous cavity with intact lens: a case report

Xie,

Chen,

Wang

et al. 2023

BMC Ophthalmol

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Background Traumatic aniridia occurs when the iris is extruded from the eye and is often accompanied by lens injuries. However, traumatic aniridia due to dislocation of the iris into the vitreous cavity without lens damage has never been reported. Case presentation A 30-year-old man presented with visual loss and pain for 6 h after a thin wire injured his right eyeball. Ophthalmologic examinations manifested a 2 mm full-thickness corneal laceration and total hyphema. An intact clear lens, healthy attached retina, and almost complete iris tissue in the vitreous cavity were found after resolution of hyphema the next day. Further examination revealed that the defect in the zonule below the corneal wound was the path for the iris to enter the vitreous cavity. The patient opted for nonsurgical treatment until pigment granules and opacity were observed in the vitreous cavity after 50 days. Vitrectomy was performed to remove the dislocated iris. Conclusions The presentation of this unique case indicates that the torn iris was displaced to the vitreous cavity with an intact lens and missing local zonula instead of out the corneal laceration after a penetrating injury. The type of injury, mechanism, and force on the spot may contribute to the occurrence of this rare condition. Instead of artificial irises, tinted glasses were more appropriate treatment option for this patient. Peripheral retinal examination was essential in the management of this case. In such cases, the iris in the vitreous cavity should be resected to prevent complications.

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Section: Discussionmentioning

confidence: 99%

Traumatic dislocation of the iris into the vitreous cavity with intact lens: a case report

Xie,

Chen,

Wang

et al. 2023

BMC Ophthalmol

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“…Regarding eyes with a history of ocular surgery, the wound from previous surgery is likely to become a weak point through where the transient high IOP is released. Several cases of traumatic aniridia and expulsive iridodialysis without IOL dislocation have been reported in eyes following CCPI [2][3][4][8][9][10][11][12]. The researchers have speculated that the iris ejects via the wound upon the stroke, and then the wound closes spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Traumatic aniridia with extensive episcleral pigmentation: a case report

Yang

Liu

2022

BMC Ophthalmol

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Background Traumatic aniridia has been documented in eyes with a history of cataract extraction through a clear corneal wound. The proposed hypothesis is that the iris tissue was squeezed out from the corneal wound as it is a relative weak point. However, traumatic aniridia with extensive pigmentation of the episclera has never been reported. Case presentation A patient, who has surgical histories of trabeculectomy and cataract surgery many years ago, presented with refractory high intraocular pressure (IOP), almost complete loss of the iris, and diffuse pigmentation of the episclera after he had suffered from a contusion injury. In addition to numerous pigment particles and cells in the anterior chamber and a well-centered intraocular lens, protruding uvea tissue with overlying conjunctiva adjacent to the site of trabeculectomy was noted. Gonioscopy showed absence of the iris with clear view of the ciliary body. Conclusions The distinct presentation of this case indicates that the torn iris was displaced to the trapdoor instead of the clear cornea incision and was confined to the subconjunctival space. The scleral fistula serves as a less resistant point for releasing pressure compared to a healed corneal wound when the eye encounters a contusion injury. Further treatment options to lower IOP include repeated trabeculectomy, implantation of glaucoma drainage device, and endoscopic cyclophotocoagulation. Transscleral cyclophotocoagulation may be considered only after episcleral pigmentation has become less so as to avoid the risk of surface burn.

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“…We conducted a literature search and, including the subjects in this report, found 22 eyes of 21 subjects (6 men, 15 women) with isolated traumatic aniridia after smallincisional cataract surgery (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Considering that most of the population with a history of cataract surgery are elderly, with some exceptions, the reported patients were old and accidental falls were the most frequent cause of this rare ocular trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Many cases of isolated traumatic aniridia, i.e., aniridia leaving an intact in-the-bag fixed intraocular lens (IOL) have been reported in patients with a history of smallincisional cataract surgery [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]; all of these eyes were reported to have complete aniridia. We report one case each of total and partial aniridia after accidental falls by two elderly Japanese women.…”

Section: Introductionmentioning

confidence: 99%

Isolated traumatic aniridia with full and partial iris expulsion in pseudophakic eyes

et al. 2022

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Background Total aniridia after ocular trauma without disruption of the intraocular lens (IOL) has been reported in patients with a history of small-incisional cataract surgery. We report one case each of total and partial aniridia after accidental falls experienced by two elderly Japanese women. Case presentations Case 1. A 76-year-old woman with a history of small-incisional cataract surgery more than 10 years previously fell onto concrete and had a contusion that affected the left side of her face. At the initial visit, the best-corrected visual acuity (BCVA) was hand motions and the intraocular pressure (IOP) was 38 mmHg in her left eye (OS). A blood clot was present in the well-formed anterior chamber and expulsed iris tissue was seen beneath the conjunctiva. Exploratory surgery showed no scleral laceration other than the previous sclerocorneal tunnel. After hyphema removal, total aniridia and an intact in-the-bag fixed IOL were seen. By 4 months, the BCVA was 1.2 and the IOP was 13 mmHg OS. Case 2. An 88-year-old woman with a history of small-incisional cataract surgery more than 10 years previously had a fall that resulted in right-sided zygomatic and maxillary bone fractures. The BCVA was light perception and the IOP was 29 mmHg in her right eye (OD). Exploratory surgery showed no scleral laceration and the previous sclerocorneal tunnel was found; iris strand prolapsing from the sclerocorneal tunnel was seen. After hyphema removal, partial iris loss and an intact lens position were seen. By 1 week postoperatively, the BCVA was 0.05 OD and the IOP was 12 mmHg OD. Conclusions It has been postulated that previously created small-incision tunnels can function as release valves during blunt trauma by preventing further global rupture and limiting IOL prolapse or retinal injury. Our cases suggested this can happen even long periods after cataract surgery. The case with partial aniridia demonstrated the process of the expulsive aniridia, and its findings do not contradict the postulated mechanisms.

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Expulsive total iridodialysis through microincision phacoemulsification wound

Cited by 3 publications

References 9 publications

Traumatic dislocation of the iris into the vitreous cavity with intact lens: a case report

Traumatic dislocation of the iris into the vitreous cavity with intact lens: a case report

Traumatic aniridia with extensive episcleral pigmentation: a case report

Isolated traumatic aniridia with full and partial iris expulsion in pseudophakic eyes

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