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First Author: M.Wilczynski POLAND
Co Author(s): M. Kucharczyk
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Iridoschisis is a rare condition, which is usually bilateral, found in the elderly, which is connected with the coexistence of closed angle glaucoma. Usually, changes have the form of stromal atrophy, atrophy of the anterior layers of the iris or separation of the anterior from the posterior laminae with coexisting posterior synechiae. The purpose is to describe a case of iridoschisis with anterior and posterior synechiae, which was successfully operated for cataract using standard phacoemulsification with Malyugin Ring.
Department of Ophthalmology, Medical University of Lodz, Poland.
A 66-year old woman was admitted to the Department of Ophthalmology for a routine cataract surgery. In the past, the patient has never had any ocular surgery, however, she had a YAG iridotomy preformed in both eyes due to narrow angle glaucoma a few years earlier. During preoperative examination, in the right eye, areas of thinning of the iris stroma were visible, as well as anterior synechiae, posterior synechiae and an iridotomy. The surgery was performed under local, topical drops, two OVDs were used in a "soft-shell" technique. The posterior and the anterior synechiae were separated and removed and the Malyugin Ring was introduced to the anterior chamber. Next, a Trypan blue solution was used to stain the anterior capsule, capsulorrhexis was done with Utrata forceps, phacoemulsification was performed and a single-piece acrylic foldable lens was implanted in the bag with an injector through the main incision. The Malyugin Ring was removed with the injector, OVDs were removed by irrigation-aspiration.
The postoperative course was uneventful, and postoperative uncorrected distance visual acuity (UCDVA) after one week was 0.9. In the postoperative examination, the pupil was round with no synechiae, but with visible areas of the iris stroma thinning nasally.
The presented case indicates that Malyugin ring may be a good intraoperative tool, which may assist the surgeon in cases of cataract with iridoschisis and synechiae causing narrow pupil. To the best of our knowledge, this is the first case in which Malyugin Ring was used during phacoemulsification in an eye with iridoschisis and both anterior and posterior synechiae.