Femtosecond laser cataract surgery in a patient with traumatic iridodialysis
First Author: Hung YuanLin TAIWAN
Co Author(s): Ning Chia Wang Pi Jung Lin
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Traumatic iridodialysis is a complicated situation in the cataract surgery. Femtosecond laser cataract surgery improves the surgical outcome and safety significantly. We report for the ﬁrst time the presentation of a patient of senile cataract with traumatic iridodialysis undergoing femtosecond laser cataract surgery.
: Universal eye center, Taipei, Taiwan
Case report: A 60-year-old man suffered from blunt trauma to his left eye while working about twenty years ago. Best corrected visual acuity was 20/20. The cornea was clear, no traumatic cataract was found but iridodialysis without visual axis blockage was noted. In recent 2 years, he experienced progressive blurred vision in the left eye. Best corrected visual acuity was only 20/200. Slit-lamp examination showed nuclear sclerosis grade III cataract and decentrated pupil with 3-clock-hour (90 degree, from 3 o’clock to 6 o’clock) iridodialysis in his left eye. The pupil size was 7 mm after dilation and slight pupil irregularity was caused by iridodialysis (largest diameter 7 mm, smallest 6 mm). Two weeks later, the cataract surgery was performed using the Alcon/LenSx FS laser system (Alcon/LenSx, Aliso Viejo, CA) to create a 4.5-mm capsulorrhexis, lens fragmentation, 2.4-mm corneal incision and 0.9-mm side-port incision. Intraoperatively, the size of dilated pupil is adequate for an intact 4.5-mm capsulorrhexis. The following surgery was uneventful. The capsule was intact and the lens fragments were removed with Infiniti (Alcon/LenSx, Aliso Viejo, CA). A multifocal intraocular lens Restore (Alcon/LenSx, Aliso Viejo, CA) was implanted in the capsular bag successfully.
One week after the surgery, uncorrected distance visual acuity was 20/20 and he could also read newspaper very well. Iridodialysis with pupil decentration didn’t affect the surgical outcome in our patient.
Cataract surgery is a very common ophthalmic procedure worldwide. However, cataract secondary to ocular contusion injuries is often associated with posterior segment sequelae and poor visual outcomes.2 Iridodialysis is one of the most common patterns of iris injury after severe blunt injury.
Femtosecond laser deliver ultra short pulses of energy at near infrared wavelengths. FS cataract lasers not only create a better wound architecture and a precise shape, diameter and well centered capsulorrhexis but also reduce the total phacoemulsification power and time. Effective phacoemulsification power and time is important for avoiding the further damage to the zolune and the capsule.
FS cataract surgery really provides safety and avoids the complications intraoperatively in our patient with traumatic iridodialysis. FINANCIAL INTEREST: NONE