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Traumatic aniridia: where is the iris gone?

Poster Details

First Author: Z.Ashena UK

Co Author(s):    H. Lee   N. Kopsachilis                 

Abstract Details

Purpose:

Small clear corneal incision (CCI) for cataract surgery is now the mainstay for most cataract surgeons. We report a case of traumatic aniridia expulsed through a three year old 2.2 mm CCI wound in a 65 year old pseudophakic patient.

Setting:

Moorfields Eye Hospital casualty

Methods:

A 65 year old woman was referred to our eye casualty after having a fall and blunt left eye injury. She had bilateral cataract surgery through a CCI three years ago. Visual acuity was 6/6 in the right and 6/60 in the traumatized left eye. IOP was 14 mmHg in the right and 28 mmHg in the left eye. Examination showed complete aniridia of the left eye and a deep anterior chamber with 2mm hyphaema, inflammatory and red cells. The intraocular lens was central in the posterior capsular bag and clear. Fundoscopy of the left eye was unremarkable.

Results:

The patient was diagnosed with traumatic aniridia with presumed expulsion of iris through the 2.2 mm wound as there was evidence of pigment in the corneal tunnel. She was commenced on G Dexamethasone 0.5% 2hourly for 2 weeks. Two weeks following her injury her VA improved to 6/36 in the left eye. The patient was referred for prosthetic iris insertion to address her photosensitivity and glare once the hyphaema and inflammation settled.

Conclusions:

Traumatic aniridia in pseudophakic patients can happen due to the impact of the blunt injury compressing on the globe, where the self-sealing CCI or corneo-scleral wounds dehisce acting as a pressure valve allowing the iris to be expulsed. According to the literature, traumatic aniridia was reported as early as 1 month up to 6 years post-operatively. The size of the CCI ranged between 2.2 mm and 5.25 mm. This is the first case of traumatic aniridia with expulsion of iris through a 2.2 mm corneal incision as late as 3 years post cataract surgery.

Financial Disclosure:

NONE

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