Challenges In Cataract Surgery With Iris Coloboma: A Case Report

To illustrate the challenges encountered and the surgical approach undertaken in cataract surgery with iris coloboma, emphasizing the importance of meticulous planning and execution in achieving successful outcomes.

The case occurred in a tertiary eye care center (Centro Cirúrgico Bela Vista, Sao Paulo, Brazil) equipped with advanced surgical facilities and expertise in managing complex ocular conditions.

A 27-year-old female presented with iris coloboma and subcapsular cataract graded 2-3+. Preoperatively, the patient's visual acuity was limites to 20/400, with a measured potential visual acuity of 20/200. Despite challenges such as poor pupillary dilation and inferior zonular fragility within the coloboma area, the necessity and feasibility of cataract surgery were established. Three iris hooks were utilized to optimize visualization, and surgery proceeded cautiously with low parameters to minimize zonular stress. The patient's young age posed additional challenges, including the greater elasticity of the capsular bag. A smaller-than-usual capsulorhexis was initiated, followed by enlargement using coaxial scissors. After phacoemulsification and cortical clean-up, a capsular tension ring was inserted to stabilize the capsular bag and a toric intraocular lens was implanted. Pupiloplasty was also performed with three sutures to approximate the coloboma edges. With meticulous preoperative assessment and intraoperative management, the surgery proceeded smoothly without encountering significant complications or vitreous loss. Postoperatively, the patient achieved a visual acuity of 20/30 without correction, with maintained centration of the pupil and intraocular lens.

Cataract surgery in patients with iris coloboma demands meticulous preoperative planning and intraoperative adaptability to overcome challenges such as poor pupillary dilation and zonular weakness. A tailored surgical approach involving iris hooks, careful capsulorhexis management, and capsular support devices can lead to satisfactory visual outcomes and patient satisfaction in this complex scenario.