Game, Set, Match: Three Stage Repair Of Iridodialysis And Lens Subluxation Post Tennis Racquet Injury

To describe the management dilemmas faced in managing ocular trauma and demonstrate that multiple procedures may need to occur over a long period of time to eventually reach a good outcome for the patient 

Singapore National Eye Centre

A 42-year-old patient presented post blunt trauma – accidentally hit in the face by his son with a tennis racquet. On first presentation, he was noted to have almost 270° of iridodialysis, hyphaema with an intraocular pressure of 28,  a subluxed lens with vitreous in the anterior chamber and a lid laceration. His lid laceration was repaired and his hyphaema and secondary glaucoma were managed with topical medications. Within a week, the hyphaema had resolved and a decision was made to first repair his iridodialysis before attempting to manage the subluxed lens.

3 weeks after his iridodialysis repair, an attempt to perform phacoemulsification with capsular tension devices and an anterior vitrectomy was undertaken. However, with the extensive vitreous loss and lack of capsular support, the decision was made on table to convert the surgery into a pars planar vitrectomy and modified yamane technique scleral fixation of an intraocular lens. In the process, part of the superior iridodialysis repair was affected and recurred. While the patient was refracting to 6/7.5 1 month post operatively, he did find that he was having a significant shadow within his inferior visual field.

The patient initially used a coloured contact lens to manage his dysphotopsia but felt it was detrimental to his quality of life, so 1 year after the initial injury, he underwent a second iridodialysis repair leading post op outcome of 6/7.5 without dysphotopsia.

This case was a management dilemma in terms of deciding on the most suitable operations to undertake as well as the timing of said operations because of the extent of iridodialysis and lens subluxation. The second surgery inadvertently undid some of the initial iridodialysis repair which the patient tolerated for some time but eventually required a third and hopefully final surgery to reach the desired outcome.