Traumatic Aniridia During Extracapsular Cataract Surgery - PowerPoint PPT Presentation

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Traumatic Aniridia During Extracapsular Cataract Surgery

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Another possibility is whether or not both patients may have some form of intraoperative floppy iris syndrome ... iris in her other eye was found to be floppy ... – PowerPoint PPT presentation

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Title: Traumatic Aniridia During Extracapsular Cataract Surgery


1
Traumatic Aniridia During Extracapsular Cataract
Surgery
  • Karen Chia, MD
  • Lavanya Raghavan, MD
  • Zainah Alsagoff, MD

There are no financial relationships to disclose.
2
Introduction
  • Extra-capsular cataract extraction is important
    for the resident to learn well as it is used for
  • advanced cataracts or
  • in patients with multiple eye conditions where
    phacoemulsification is not suitable.
  • It may also be necessary to convert a case of
    phacoemulsification to ECCE at times when
    complications occur.

3
  • It is important thus to know complications of
    ECCE.
  • Here we describe two rare cases of total aniridia
    during ECCE

4
Case 1
  • A 85 year old female underwent cataract surgery
    by a resident under consultant supervision.
  • Pre-operative best corrected visual acuity (BCVA)
    was 6/45. Cataract was nuclear sclerosis 4.
    Pupil was small and there was difficulty in
    dilation. ECCE was performed and during nucleus
    expression there was expulsion of the iris during
    nucleus delivery.
  • Infusion-aspiration was continued and eventually
    a standard IOL was inserted into the bag.

5
  • Her BCVA was 6/24. She had no complaints of
    glare. Intra-ocular pressure remained within
    normal with no retinal complications. Tinted
    glasses were advised.
  • A phacoemulsification done for her other eye a
    couple of months later and the surgeon noted a
    floppy iris.

6
Post Operative Images
7
Case 2
  • 59 year old male with history of benign prostatic
    hypertrophy, on terazosin, underwent ECCE.
  • Pre-operative BCVA was 6/12. Cataract was nuclear
    sclerosis 3. Similarly there was iris expulsion
    with the nucleus delivery.

8
  • BCVA was 6/6. He was a driver and had photophobia
    and was bothered by the glare. Initially he tried
    colored contact lens but he was unable to
    tolerate it. Six months later, he underwent
    Morcher ring implantation. He developed glaucoma,
    which required treatment with 2 eyedrops.

9
Post Operative Images
10
Discussion
  • It is extremely uncommon for total aniridia to
    occur during ECCE. Various reasons for their
    occurrence are as follows
  • In case 1, the resident may have accidentally
    tugged on the iris with the calibri.
  • In case 2, there may have been excessive pressure
    applied on the inferior limbus during nucleus
    expression.

11
  • Another possibility is whether or not both
    patients may have some form of intraoperative
    floppy iris syndrome (IFIS)
  • In case 1, she had a small pupil intraoperatively
    and the iris in her other eye was found to be
    floppy during phacoemulsification
  • In case 2, the patient was on terazosin. There is
    only one case report so far of IFIS with
    terazosin.

12
Prevention
  • Surgeons have to take extra care during surgery,
    especially during nucleus expression
  • A good history must be taken to highlight cases
    possible IFIS
  • In cases of possible IFIS, iris hooks or
    intracameral epinephrine may be useful.
  • Managing the complications is important as well.
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