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A novel approach to the management of traumatic phacocele with iris loss

Poster Details

First Author: G.Yong MALAYSIA

Co Author(s):    A. Yee   X. Ting   S. Pan   J. Mohamed Noor   M. Zahari        

Abstract Details


Traumatic phacocele is a rare complication of blunt trauma, in which rupture of the sclera results in dislocation of the crystalline lens into the subconjunctival space. We report a case of traumatic phacocele with iris loss where the surgical management included the use of a tripodal anterior chamber intraocular lens (ACIOL).


Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia; Department of Ophthalmology, Sibu Hospital, Sarawak, Malaysia


A 77-year-old woman presented with left eye pain, headache and acute blurring of vision after the left eye was traumatised by a piece of wood. At presentation, her left eye could only see hand movements. Examination revealed a hazy cornea, a 4mm hyphema with a quadrant of iris loss superiorly. There was a superonasal subconjunctival cystic mass. The intraocular pressure was 4mmHg. There was no relative afferent pupillary defect in the affected eye. Computerised tomography showed an aphakic left eye with the crystalline lens seen at the superonasal subconjunctival area. There was no evidence of vitreous haemorrhage or retinal detachment.


Surgery of the left eye was performed under local anaesthesia. There was a 11mm superonasal scleral wound with iris remnant. The lens was removed from the subconjunctival space, and the sclera and conjunctival wound repaired. Anterior vitrectomy was performed. Due to the poor view from corneal oedema and hyphema, an ACIOL was implanted two months later. A uniquely designed tripodal ACIOL with 14 degree angulated haptics was used due to the presence of a large iris defect. Postoperative vision improved to 6/18, with a normal intraocular pressure and stable ACIOL.


Good clinical judgment, early medical and surgical intervention along with an appropriate IOL selection is instrumental to achieving a good visual outcome in a case of traumatic phacocele with moderate iris loss.

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