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Iris coloboma and cataract surgery challenges

Poster Details


First Author: A.Dan ROMANIA

Co Author(s): G. Mercut   I. Mercut                 

Abstract Details

Purpose:

To describe a complex cataract surgery case due to extensive iris colobomas, zonular deficiency and hyperopia. Iris colobomas occur from failed or incomplete closure of the embryonic fissure during the first trimester of gestation. The defect can occur sporadically or inherited and may be associated with systemic disorders.

Setting:

Ophthalmology Department, Irina Medical Centre, Craiova, Romania.

Methods:

A 30-years-old female patient presented to our department complaining of gradual loss of visual acuity bilaterally. Her best-corrected visual acuity (BCVA) was 0.4 right eye (RE) with +3.25 spherical diopters (SD) and 0.5 left eye (LE) with +3.75 SD. Slit-lamp examination revealed extensive iris colobomas bilaterally in the inferonasal quadrants and subcapsular lens opacities. Zonular deficiency was present in the corresponding area of the colobomas. Phacoemulsification was performed successfully in BE. The surgical steps were difficult to complete because of the narrow anterior chamber, unresponsive pupil, zonular deficiency, fragile and elastic anterior capsule and an unstable lens.

Results:

Postoperatively the BCVA reached 0.9 bilaterally one month after surgery. The IOL was centered and the posterior capsule was clear. Our patient presented with colobomas too wide to be corrected and the shallow anterior chamber excluded an artificial iris insertion. The iris colobomas were not associated with microphthalmia, but the intraoperative characteristics of the anterior capsule and lens opacities suggested a congenital cataract. One year after surgery the patient developed posterior capsule opacification bilaterally which was treated with YAG laser capsulotomy. The posterior capsule was left intact in the corresponding area of the coloboma in order to avoid photophobia.

Conclusions:

At patients with iris coloboma, cataract extraction presents higher risks due to complex modifications of the anterior segment. Correction of the iris defect depends on the size of the defect and the photophobia complaint. For patients who struggle with photophobia, cosmetic contact lenses are a reliable alternative.

Financial Disclosure:

None

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