Traumatic Iridodialysis Repair During Single-Stage Cataract Surgery

To describe the successful single-stage surgical management of traumatic iridodialysis associated with a visually significant cataract using phacoemulsification, Cobbler’s technique for iris reattachment, and final pupilloplasty, highlighting a comprehensive approach for anatomical and functional restoration.

Oftalmocenter, Quito, Ecuador.

A 61-year-old male presented with a history of blunt ocular trauma caused by a high-pressure water hose. Best-corrected visual acuity was count fingers, and intraocular pressure measured 17 mmHg. Anterior segment examination revealed an iridodialysis extending from 10 to 1 o’clock, associated with a 3+ cataract, with no evidence of lens subluxation or zonular weakness. A single-stage surgical approach was performed. Cataract extraction was initiated using a Malyugin ring for pupillary expansion, dispersive viscoelastic, and a continuous curvilinear capsulorhexis, followed by cautious divide-and-conquer phacoemulsification and in-the-bag implantation of a posterior chamber intraocular lens. Iridodialysis repair was subsequently carried out using Cobbler’s technique, with 10-0 polypropylene sutures passed from the iris root to the sclera and secured over the scleral bed approximately 1 mm posterior to the blue zone with controlled tension adjustment. Final pupil reconstruction was achieved with pupilloplasty, resulting in a pupil diameter of approximately 3.5 mm and a well-centered pupil.

A combined single-stage approach using Cobbler’s technique for iridodialysis repair, pupilloplasty, and cataract surgery represents an effective alternative for traumatic anterior segment injuries with coexisting cataract. Careful suture adjustment allows optimal anatomical restoration, reduces photic symptoms, minimizes intraocular lens edge glare, and provides visual rehabilitation while limiting surgical time and patient morbidity.