Flanged Iris Pupilloplasty And Toric Iol Suture In A Young Trauma Patient

To present novel flanged iris pupilloplasty and toric intraocular lens flanged-fixation used in solving the challenging case of a 41-year-old female patient who suffered penetrative ocular trauma resulting in extensive iris defect, traumatic cataract with damaged lens bag and hemophthalmus.

Clinical Hospital for Ophthalmological Emergencies Bucharest

The 41-year-old female patient suffered a penetrating ocular trauma that resulted in extensive iris defect, traumatic cataract with damaged lens bag and hemophthalmus: VA at presentation was hand-motion perception. The initial approach was surgical iris reconstruction and cataract extraction. The damaged, cataracted lens was used as a scaffold to offer an advantageous pupilloplasty position. The torn iris which was displaced from temporal to beyong central position was repaired with multiple 10-0 prolene sutures. After performing external-internal suture passage using a straight needle we used a guide needle to aid internal-external passage. This resulted in a U-shaped external-internal-external passage. The technique was repeated a second time leaving two U passages without scleral tightening of the suture ends. The opacified hydrated lens was extracted using aspiration and vitrectomy. The two U-shape sutures were tightened by using a diathermy to flange the individual 10-0 prolene ends, resulting in two scleral flanges per U suture or four total scleral flanges. A second surgery 3 months later sutured a toric intraocular lens using a flanged externalized haptic technique. Postoperative evolution: partial hemophthalmus after the first surgery and two episodes of cystoid macular edema months-later; All of these were resolved each time using medical therapy. Uncorrected visual acuity at 6 months after the second surgery was stable at 0.8 decimal and 1 with correction.

Flanged-fixation can also be used to perform pupilloplasty using multiple U-shaped sutures to reposition the iris and flanged suture ends to anchor it to the sclera. This technique eschews the necessity of creating scleral pockets for U-suture knots. The same flanged technique can also be used in subsequent IOL fixation and is stable enough to fix a Toric IOL. Combined Flanged Iris and IOL suture can successfully treat complicated ocular trauma.