Cataract Surgery With Artificial Iris Implant In A Patient With Bilateral Congenital Aniridia, High Hyperopia And Corneal Opacities

The purpose of this paper is to present the difficulties and complications which may appear during the cataract surgery in a patient with congenital aniridia, corneal opacities, high hyperopia and cataract, who came for cataract surgery and is planned for phacoemulsification with posterior chamber intraocular lens (PCIOL) and artificial iris (AI) implantation.

These eyes are at high risk of complications, due to the poor visualisation determined by the corneal opacities, the small eye environment and the thick IOL which needs to be implanted together with an AI in a small capsular bag.

The case presented had surgery in both eyes, one of them went uneventful, the other one had a complication which needed to be addressed in a second procedure.

Oculus Eye Clinic – Bucharest

A 39-year-old female patient presented with: bilateral congenital aniridia and nystagmus, corneal leucomas, cataract and high hyperopia with astigmatism. She had recent significant decrease in vision and marked photophobia. Uncorrected visual acuity (VA) was "count fingers" and 0,1 with +10 spherical and 3 cylinder diopters. We scheduled her for cataract surgery with PCIOL and AI implantation.

Special surgical considerations were: preparing the AI at a diameter of 7,5 mm, to accomodate it in the small bag (assessed by the ultrasound biomicroscopy), dying the anterior capsule for a better visualisation, making an anterior capsulotomy larger than usual and enlarging the main incision to 3,5 mm for a safe implantation in the bag of the thick 35 diopters IOL and, then, of the AI, over the IOL.

During the surgery of the first eye, due to the too large capsulotomy, it was difficult to implant the AI and to keep it in the bag and, due to the poor visualisation, at the end of the surgery, we were not sure about its position. The next day we noticed it was out of the bag, in the anterior chamber, in contact with the cornea. We decided to suture it to the sclera. The reintervention led to a good position and centration of the AI over the capsular bag.

The second eye had uneventful surgery, with more controlable capsulotomy size, followed by a safe IOL and AI implantation in the bag.

The uncorrected VA improved significantly in both eyes and no postoperative complications were noticed.

The combined procedure of Phacoemulsification with PCIOL and artificial iris may be an ideal solution for patients with this condition. The surgery is fraught with difficulties and risks, determined especially by the poor visualisation during the surgery and to the special requirements related to the AI implantation.

As in our case, treating the complications may require, a reoperation.

This case shows that learning a lesson from the mistakes and complications of the first eye surgery is very useful to avoid them during the surgery of the second eye.

Despite the good postoperative results, these eyes need constant monitoring to detect and treat potential sight-threatening complications, like secondary glaucoma and corneal decompensation.