4X4: FOUR-FLANGED INTRASCLERAL IOL FIXATION, SINGLE-PASS FOUR-THROW PUPILLOPLASTY AND VITRECTOMY WITH SILICONE OIL TAMPONADE IN A PATIENT AFTER BLUNT TRAUMA

A fifty-nine-year-old patient underwent blunt trauma involving wood while working with a saw on 27th May 2022. Ten years earlier, he had been struck and suffered a nasal bone fracture. On admission on 8th June 2022, he presented with a BCDVA of 0.01 and an IOP of 10mmHg. Slit-lamp examination revealed a subluxated post-traumatic cataract disabling fundoscopy, iris damage and atonic, wide, irregular pupil. Ultrasound examination revealed vitreous hemorrhage and choroidal detachment.

Ophthalmology Department, Medical Unversity of Bialystok, Poland.

On 8th June 2022, the following procedures were performed. A 23-gauge pars plana vitrectomy, lensectomy with 20-gauge vitrector, four-flanged intrascleral intraocular lens (IOL) fixation as by Canabrava et al. and single-pass four-throw pupilloplasty according to Agarwal et al, followed by posterior vitreous detachment, endolaser and silicone oil tamponade. Consecutive steps of this combined procedure are presented on a film. On 14th September 2022 another 23-gauge vitrectomy with silicone oil removal was performed. 

Follow-ups within the timespan of three months between two vitrectomies showed stable BCDVA 0.7 and IOP results within normal limits under anti-glaucoma monotehrapy with normal macular anatomy shown on optical coherence tomography (OCT). After the second intervention, on 22th September 2022, UCDVA 0.7, IOP 17mmHg, on autorefractometry +0.25Dsph/-0.5Dcyl ax78. OCT showed normal macular thickness and profile. 

In the presented case, anterior segment surgical management with four-flanged intrascleral IOL fixation and single-pass four-throw pupilloplasty proved suitable as an iro=is-lens diaphragm during the perfomance of vitrectomy with silicone oil tamponade. Furthermore, the follow-up period until second vitrectomy was uncomplicated. Six month follow-up after second vitrectomy with silicone oil removal showed stable BCDVA, IOP and anatomical results. Longer-term results are awaited.