Bag In The Lens (Bil) Procedure For Early Cataract In An Adult Patient With Iris Coloboma

To report the succesfull surgical case of bag-in-the-lens (BIL) procedure for early cataract in an adult patient with branchio-oculo-facial syndrome presenting with iris coloboma.

The ophthalmology department of a Belgian tertiary centre (University Hospital of Brussels).

A 35-year-old male with Branchio-Oculo-Facial syndrome (BOFS) was referred for predominantly unilateral gradual decrease in visual acuity in the right eye. Upon examination, bilateral cataract with iris coloboma was diagnosed. The patient underwent a unilateral BIL procedure for cataract in the right eye under general anesthesia. Pre- and intraoperatively, special considerations were made due to the ocular comorbidities associated with BOFS, including the presence of iridal and chorioretinal coloboma.

The lens was successfully removed by phacoemulsification and the intra-ocular lens (IOL) was implanted after anterior and posterior rhexis to accomodate to the alternate visual axis. Intra-operatively zonular instability was observed, and lens prolapse occurred. Furthermore, anterior vitrectomy was performed on fibrotic anterior hyaloid, which was indicative of vitreopathy. Post-operatively, significant corneal edema was noted but had gradually resolved by the one-month follow-up. At this last available follow-up, the best-corrected visual acuity improved from 6/126 preoperatively to 6/60, and the patient reported enhanced color vision.

This case emphasizes the success of the Bag-in-the-lens procedure for patients presenting with iris coloboma.