Aniridia, Aphakia And Corneal Scarring - One Procedure To Fix Them All

Ocular blunt  trauma can result in serious complications such as vitreous hemorrhage, retinal detachment, and iris defects. Its’ management often requires multiple interventions and poses a great challenge for the surgical team.

We present the case of a 54-year-old phakic man with no ophthalmologic past history who suffered ocular trauma on his right eye, with a penetrating corneal wound and subsequent aphakia, aniridia and corneal scarring.

Department of Ophtalmology, ULS São José

The patients' BCVA in the ER was light perception and slit lamp examination showed a complex corneal injury, with iris and vitreous prolapse and anterior segment disorganization. Immediate corneal wound repair was performed with subsequent anterior vitrectomy  and lensectomy due to an intumescent lens. Slit-lamp examination showed extensive corneal scarring, subtotal aniridia with minimal remnant iris tissue and aphakia. B-scan ultrasound showed an attached retina with no signs of proliferative vitreoretinopathy. Six months after the initial traumatic event the patient underwent simultaneous treatment of aphakia, aniridia and corneal scarring  with an iris-intraocular lens complex (Reper®) with scleral fixation and penetrating keratoplasty. At the 4-month follow-up appointment the patients’ BCVA was 2/20, in spite of the corneal sutures. Anterior segment examination showed a transparent corneal graft, with the Reper device centered and minimal anterior segment inflammation. No postoperative complications were noted. Fundoscopy was unremarkable. 

The simultaneous treatment of corneal scarring, aphakia and aniridia is a rare and complex procedure. This case presents with very favorable anatomical and functional results.