Management Of Refractive Surprise And Traumatic Mydriasis With Intraocular Lens Exchange And Artificial Iris Implantation.

To describe a case of refractive surprise management following traumatic cataract surgery with traumatic mydriasis.  

University Hospitals Sussex NHS Foundation Trust, Brighton. UK

A 59 year had a history of trauma from an elastic bungy cord. He developed traumatic cataract and a fixed dilated pupil with visual acuity of counting fingers. His commotio retina in the periphery settled without any complications. He underwent successful cataract surgery at a neighbouring hospital. However, he ended up with a  huge referactive error as the patient forgot to mention his previous history of LASIK and the surgeon did not notice the LASIK flap. His vision improved to 6/60 unaided with lot of glare from fixed and dilated pupil. He ended up myopic following his procedure and his vision with correction was 6/6. 

He was referred to us for iris repair and referactive surprise management. After detail discussion of risks, benifits and alternatives, he underwent a succesful monofocal intraocular lens (IOL) exchange with extended depth of focus IOL in the capsular bag and insertion of custom made artificial iris in the sulcus. His postoperative vision, 3 months after the surgery was 6/6 unaided and N8 unaided. This video case report will discuss the tips and tricks for safe and successful IOL exchange with customised artificial iris insertion. 

Artificial iris implantation can be an option for traumatic mydriasis. This procedure can be combined with IOL exchange procedures with premium IIOLs such as the extended depth of focus IOL. This video case report shows the tips and tricks for safe IOL exchange and artifical iris implantation.