Cataract Surgery In Patients With Congenital Iris Defects: Surgical Strategy And Clinical Outcomes

Congenital defects of the iris, including iris coloboma, are rare developmental abnormalities with an estimated prevalence ranging from 1 to 7 per 100,000 individuals. Patients with such anomalies frequently develop cataract at a younger age compared to the general population. Cataract surgery in these cases presents serious technical challenges due to abnormal iris anatomy, potential zonular weakness, and altered anterior segment configuration, which may increase the risk of intraoperative complications.

The purpose of this study was to evaluate surgical approaches and clinical outcomes of cataract surgery in patients with congenital iris defects, emphasizing individualized surgical planning and the use of modern microsurgical techniques.

This study presents a series of 7 clinical cases involving patients with complicated cataract associated with congenital iris coloboma who underwent phacoemulsification with intraocular lens (IOL) implantation. All surgeries were performed at the S. Fyodorov Eye Microsurgery Federal State Institution during past 3 years.

Preoperative evaluation included a comprehensive ophthalmic examination consisting of visual acuity assessment, slit-lamp biomicroscopy, intraocular pressure measurement, optical biometry, and detailed anterior and posterior segment evaluation.

Particular attention was given to the morphology and extent of the iris defect, as well as the condition of the zonular apparatus and capsular bag. Surgical planning was individualized depending on the anatomical characteristics of the anterior segment.

Phacoemulsification was performed using microincisional techniques with careful capsulorhexis formation and controlled nucleus fragmentation. In selected cases, femtosecond laser-assisted cataract surgery was performed. 3 patients (42%) had pupilloplasty at the time of cataract surgery to reduce glare and to improve cosmetic outcome. In 2 cases (28%) an underwater diathermocoagulator was used during cataract surgery to correct the shape and position of the pupil. 2 patients (28%) underwent post-operative YAG-laser pupilloplasty to correct pupil position and expand the visual field.

Cataract surgery in patients with congenital iris abnormalities is technically challenging and requires careful preoperative assessment and individualized surgical planning. Our results demonstrate that modern phacoemulsification techniques combined with appropriate intraoperative management allow safe and effective treatment of cataract in these patients.

Significant visual rehabilitation and aesthetic resulsts can be achieved even in the presence of pronounced iris defects. These findings emphasize the importance of a tailored surgical approach and modern microsurgical technologies in managing cataract associated with congenital iris anomalies. Further studies with larger cohorts are required to optimize surgical strategies and outcomes.