Traumatic Aniridia 2 Years After Phakic Implantation
Published 2023 - 41st Congress of the ESCRS
Reference: PO0098 | Type: Case report | DOI: 10.82333/xdv4-gw04
Authors: Raphaël Barugel* 1 , Camille Rambaud 2 , Vincent Borderie 1 , Nacim Bouheraoua 1
1Centre Hospitalier National d'Ophtalmologie des 15-20,Paris,France, 2Institut Laser Ophtalmologique Voltaire,Paris,France
We describe a case of traumatic expulsion of the iris after phakic IOL implantation following a low-velocity injury and discuss its management.
The patient had undergone bilateral toric ICL phakic IOL implantation (Visian ICL, Staar Surgical Co) two years prior to presentation for correction of high myopia. The patient presented to the ophthalmology emergency department with total unilateral hyphema following a trauma from a corner of furniture. Spontaneous resolution of the hyphema revealed complete aniridia. The decision was made to closely monitor the ICL.
The patient underwent bilateral phakic IOL implantation with toric ICLs at the age of 27 for -11.25 (-1.25)165 in the left eye and -9.50 (-1.50)10 in the right eye without incident.
Examination after spontaneous washout of the hyphema (day 2 after trauma) revealed complete aniridia, 60° rotation of the implant, visual acuity of 10/10 with +1.00 (-2.50 at 175°), normal intraocular pressure, average endothelial cell density of 3022 cells/mm2 in the left eye and 3043 cells/mm2 in the right eye, vaulting of 820μm in the left eye and 490μm in the right eye, clear lens, and no remarkable fundus changes.
Six months follow-up showed stability of central endothelial cell count and a decreased vaulting (720μm after one week and stable at 680 μm after one month). The decision was made to keep the ICL under surveillance as long as vaulting and endothelial cell count remained stable to avoid significant anisometropia.
This is the first reported case of a conservative management after traumatic iris expulsion with phakic IOL implantation. There is only one similar case reported 2 years after ICL implantation, which occurred after a high speed car accident.
In the latter case, the decision was made to wash out the hyphema a few days after the trauma due to an elevation of IOP to 40mmHg and the implant was removed during the same procedure to protect the endothelium from potential implant instability.
Traumatic iris expulsion on phakic IOL is an extremely rare complication, which can occur following low velocity trauma. In case the implant is left in place, close monitoring is essential.