Flanged Iris Pupilloplasty And Toric Iol Suture
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT028 | Type: Case Report | DOI: 10.82333/m1t8-bf80
Authors: Dr Paul Filip Curcă 1 , Prof. Dr Călin Petru Tătaru* 2 , Dr Cătălina Ioana Tătaru 3 , Dr Cristina Cojan 4 , Dr Maria Cristina Halici 4 , Dr Dinu Bogdan Tiutiucă 4 , Dr Emanuela Băcăoanu 4
1Ophthalmology,Central Military Emergency Hospital Dr. Carol Davila, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania, 2Ophthalmology,Central Military Emergency Hospital Dr. Carol Davila, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania;Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania;Alcor Clinic,Bucharest,Romania, 3Ophthalmology,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania;Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania;Alcor Clinic,Bucharest,Romania, 4Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania
Purpose
To present novel flanged iris pupilloplasty and toric intraocular lens flanged-fixation used in solving the challenging case of a 41-year-old female patient who suffered penetrative ocular trauma resulting in extensive iris defect, traumatic cataract with damaged lens bag and hemophthalmus.
Setting
Retrospective case report.
Report of case
A 41-year-old female patient was referred after suffering penetrative ocular trauma which resulted in extensive iris defect, traumatic cataract with damaged lens bag and hemophthalmus. Visual acuity at presentation was hand-motion perception. The torn iris which was displaced from the original temporal position to beyond central position was repaired using multiple 10-0 prolene sutures. Multiple flanged sutures were used to perform pupilloplasty. Each suture is U-shaped, first with an external-to-internal passage, then passage through the displaced iris tissue, then return passage interior-to-exterior aided by use of guide needle. The resultant U-shaped suture is tightened without yet flanging to return the iris tissue to anatomical position. The opacified hydrated lens was extracted using aspiration under anterior chamber infusion and anterior vitrectomy was performed. Final suture adjustments were now performed via diathermy flange. The second surgery performed 3 months later sutured a toric intraocular lens using a flanged externalized haptic technique. We recommend first placing the IOL above the eye to correctly visualize the position of the IOL haptic ends; guide markings are then placed. Postoperative evolution included partial hemophthalmus after the first surgery and two episodes of cystoid macular edema months-later; successfully resolved using medical therapy. UCVA at 6 months after the 2nd surgery was 0.8 decimal and BCVA 1.
Conclusion/Take home message
Flanging both iris and toric IOL sutures is an innovative approach to resolving complicated ocular trauma. For this purpose, we recommend individual U-shaped sutures for pupilloplasty since they are individually adjustable, with final tightening at the end of the surgery. For toric IOL suture correct visualization and marking of the desired haptic positions is crucial; the flange technique is simply adapted to the new haptic positions.