Seeing Beyond The Break - Repairing Traumatic Iridodialysis With A Tailored Approach

Ophthalmology Department of Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal.

Ophthalmology department of Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal

This is the case of a 71-year-old man with a history of a left eye trauma several years before. He  mentioned initial complaints of intermittent monocular diplopia that disappeared later on. On observation he had best corrected visual acuity (BCVA) of 8/10 in the right eye and 3/10 in the left eye (Snellen Chart) with normal intraocular pressure (IOP). Biomicroscopy revealed inferior iridodialysis with zonula absence in the local or iris defect and a cataract. Fundoscopy showed a temporal retinal scar without macular involvement. This situation was faced in one time surgery: we started by creating two corneal ports and performed gentle anterior capsulorrhexis, viscodissection and hydrodelineation followed by phacoemulsification of the nucleus. Then a capsule tension ring was placed to avoid increased zonular traction. Then, we performed gentle cortex aspiration with bimanual technique associated with viscodissection. After that. After that, a one piece foldable IOL was implanted. To repair the inferior iris defect, we opted to insert a Morcher 67B iris segment implant in the sulcus, cutted and tailored to the size needed using thermal cauterization (that revealed being a frightining maneuver). The implant was then gently rotated to stay right underneath the defect. Postoperative BCVA was 8/10, with a centered prosthesis. The patient reported resolution of diplopia, with a very good aesthetic result.

This video intends to highlight the complexity of surgical decision and techniques for repairing iris defects. Sometimes a costumized approach can be a very suitable option taking into account every patient's needs in order to allow the resolution of the symptoms and to obtain a good cosmetic, anatomical and functional result.