Iatrogenic Zonular Trauma During Iridectomy/ Trabeculectomy For Congenital Glaucoma Resulting In A Rare Acquired Lens Pseudo-Coloboma: Presentation And Considerations For Future Cataract Surgery

To report a rare case of acquired lens pseudo-coloboma following iatrogenic zonular trauma during iridectomy performed as part of trabeculectomy for primary congenital glaucoma (PCG) and to discuss its implications for future cataract surgery.

Tertiary ophthalmology center at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. 

A case of a 23 year old female patient who developed an unilateral acquired lens pseudo-coloboma following Iatrogenic Zonular Trauma happened during Iridectomy/ Trabeculectomy surgery performed for PCG at age of 2 month old. The patient had no systemic abnormalities. Postoperative findings, clinical imaging including high quality slit lamp photos, anterior segment optical coherence tomography (AS-OCT), and ultrasound biomicroscopy (UBM) were obtained. A comprehensive literature review was conducted to analyze the etiology of the lens deformity and to outline key considerations for future cataract surgery.

Isolated acquired lens pseudo-coloboma is a rare but significant complication after pediatric glaucoma surgery. It can lead to considerable visual impairment due to refractive errors, amblyopia, and challenges in surgical management. Appropriate surgical techniques are essential to minimize intraoperative and postoperative complications. Understanding its pathogenesis enables prevention, early diagnosis, and strategic surgical planning. Future cataract surgery in such eyes requires meticulous preoperative assessment and tailored surgical approaches to manage zonular instability and optimize long-term visual rehabilitation.